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PHYSIOLOGICAL AND PATHOLOGICAL EFFECTS 
OF SEVERE EXERTION (THE MARATHON 
RACE).* 


GENERAL OBSERVATIONS.; 


WATSON L. SAVAGE, M. D., ASSISTED BY DR. E. S. DICKEY, DR. C. B. 
MCABOY, DR. C. ORBIN, AND DR. A. W. WOODBURN. 


One of the decisive battles of the world was fought in the year 
490 B. C. Mailtiades, a Greek general, commanding an army of 
but 11,000 men, defeated the Persians, numbering over 100,000. 


The conflict took place on the plain at Marathon. After the 


battle a soldier was dispatched to carry the news of victory to 
Athens, a distance of 40 kilometers (24.85 miles’). “As he reached 
his destination, having run without stopping, and as he emitted 
the words, “ ‘Victory i is ours,” he fell dead. 

In 1896 the Grecian government established the cotirse covered 
by this unknown soldier as an official event of the Olympic games. 
America was not especially interested in this until an American 
youth, in 1908, won the race. Since then it has become popular 
on this continent; it has, in fact, become almost a craze with the 
American boys to train for and compete in these races. 

It can easily be seen what a fertile soil for study the partici- 
pants in this race could furnish and that such a study should pro- 
duce facts of immensé Wlue: toward determining, if possible, to 
our own satisfaction, the ever- recurring question as to the bene- 


ficial or harmful effects of such a‘severe exertion as this. Not : 
only the visible immediate effects, but also the unseen remote *~ 


effects must be seriously considered. This study includes obser- 
vations upon youths and men from the various walks of life, 
already by far above the average in physical vigor, because they 
are the pick from large groups of men and boys scattered over 
our entire district. 

At a time such as the present, when Marathon racing is so popu- 
lar, and when it must be that many who are physically unfit enter 
into this sport, the thorough understanding of the effects of so 
severe a: form of exertion as this is of the utmost importance. 
Toward this end, the Department of Physical Research of the 
Pittsburg Athletic Association devoted its inaugural undertaking 
to the study of the participants in the Marathon race of June 26, 
ROOD ev 

*From the Department of Physical Research, Pittsburgh Athletic Association. 
Directed by WATSON L. SAVAGE, M. D. 


+Presented, by invitation, before the College Gymnasium Directors’ Society, at the 
Columbia University, December 31, 1909. 


Up to the present there have been comparatively few observa- 
tions upon Marathon runners. These observations, while they 
were made by most competent observers, in nearly all instances, 
were carried out upon small groups of men at irregular times 
and in each series they covered only a comparatively few phases 
of the entire subject. The reports of this work are referred to 
in the appended bibliography. 


Nothing so determines the success or failure of such a series 


of observations as these, as the control that the observers have 
over the men and the discipline of the contestants. Having this, 
through the liberality and interest of the Association and the con- 
testants themselves, we proceeded to carry out the following 
observations which may be classified under three headings: 


(1) The general observations. 

(2) X-Ray examinations. ° 

(3) Observations upon the cardio-vascular and renal systems. 

We compiled the following questions to be filled out by the 
contestants and later recorded the answers and our own observa- 
tions on a card so as to have nearly all our information in con- 


densed form. This makes such a work systematic and compara- 
tively easy. 


PITTSBURG ATHLETIC ASSOCIATION. 
Report of Runners in Marathon Race June 26, 1909. 


PHYSICAL EXAMINATION. 


Date. 08! Hours urs Date kee: Hour) . 2.02. Date aa Hour cee 

Before Race. Immediately After Subsequent Re-exams. 
Height’ 2. osc ce in fe SY een li SCR tm peed) eee 
Weight. oo ie ceva. wu. 5 Los tae epee bees cb eaten, eaeaen a 


Girth tAtins Rey ei te nee wav ueivs agpiesie Gy yepek 
Girth Thigh? R38. 99 eae ee ees 
Girth, Calf Reo. isa bee ween ob ois cece £5 ce eae ee 
IN utritions 66a hic res vote 6) stead 2 pace Co ace be. aa a 
Coridition © 25.2 fis wae 1 ee Eas Soe wis ae ee 


Temperature: 


Mouth \.c2es wee oe lpn do ales 6 Cae wk Oi al eer ee Ree eee glee 
Recta rk 20.05 pare rer er eet ar em 


; 
L. 
i 
& 
a 
» 
\ 
‘ 


Heart: . 
ROE tee a TU ON PN te i ee aE OP Pie vee ire) ems 


Neh AE pe | SES ORE IN NS Pont GA ie in! CL A a A Re eee 
hetero 2 cas bbe ig. ae aL Teal ta a PS We So ae MONT o te Se De maar 


LSpeMC PS SRE! eis 5 eas EER RU 2 Se aa Pare aE Vali Se oe eh ae kh 
OMS ee EE Ho OF et are tt eee ene OSs eee | aks al bee pai ym le rita 
OP MIET ER pt i FEA aig EEA OY slg ae Nel oem Coa ANT ak eR acl Soe 


CEE Sy Pr RE eS RIO ERN A AS! i im mee Mid Pi ere So hoe Beet 
LTTE og BER FE eee WA aden see od la steer Nae ae Ri et ee Oe ete oh ole RO 
Cyr ad ty Pad ea eet Sy en ee ene Oy Mai yy SN ee 
URINE ANALYSIS. 
General. 
(characteristics si:... ARPES Sahn at SNE gh fete, Mine ea ae Cn oes OMG) eee Re EE 
FP Sa SOG ogy lae SOO aa AS RS ae eR Pl pe eS ea 
eet CT MS Pee Gerri he eee neh ge ale Ee ey Goa sey ahah 
Sc. FEET Re sg RSet ie yO OR BS wok 8 eos ete Ate Sk bp aise cea 
NET TERE Pt ren rt age rier tera fee eS oS Be oe ed eS 
OE ETy 1 aA pee er ee Re on SE Rye lee Le Tee Riau | 
Prcutcnrem OCiCS fe fae Ss ake hs race us cee ei! nig Ut. Ne eee Oey 
Microscopic. 
Atta a eee ROD RARE NEO Obie air: igh Sn ocala Sos Mia SPs OL BNA aoth LOLS aa cal ee PARR Nt 
Cells 
DGt time eer yee eerie « ears oo ALS Ss 4, Reel, Se aA? 2 cme ee 
hie Gan Gb Bars eae Sat i ae eae Pans "Ste eee a ee A A ee 
Oi AE AR or eS SE) en 8 ee al, ne Me Ee CI Re Sear eo 
ut is ee acti) Aneta tere ee Oitidie Pl ada nn Ss ht Oe a 
Remarks. 
RINE SING igihl See Kaw cel ied Wathet a sake foe a ee 
Perea et eee ee Ree eth ee tN ag Om pe PT Se er Aon ee Pk 
co SG ECEY, Be oh AE oe Riga ee aelephane «Number: «02 .4st. suk au 
Working hours........ Cee yer pei te Reet ener A Seiat eh Bete Ge Ee 
3 


TIGICN TL feet eas Weight before training.......... Weight now........ 
Pulse rate morning before rising.......... Pulse rate evening..: soos 
Distance run .on\ day ofytaking evening pulse........2........ 00 «ee 


Diet’ sos Sealed Bale a ec ee ee ates ee ee OR ce ee er 


How. much coffee do you drink daily ?.... 22.5232... $222.5 ee 
How much milk do you drink daily?..... "oie «ale. Slang oe bs oe ke al ober een 
How- much water: do you drink daily?) ...5.......-. 421. 43 See 
How much beer. do you-drink daily-?.... 2... sc. 50s oe 
How much wine do you drink daily? ......0...0). 2s 
How much liquor do:you drink daily? .....4. 2.230 Le 
How many cigarettes do’ you smoke daily ?...:...1...25..2s. 2.55 oe 
How many stogies: do you smoke-daily?....3 5... +. iss s ss) eee 
How many cigars do you smoke daily?:.....2.....5.... 9. me oe 
How many pipes do you smoke daily ?.. :... <. 0.8 ae 


Write a full history of your training, giving distances and speed, as well 
as you can remember. 


ec CCC eC ewe ea tice eeiawmaeae CCK eeMe eet eat eeeerestsevsesesaees es © © 6 8.5 © dal alab Senne 
Ceoeonereeenwevreececene vce ese £0 60. 8 8 6 © 20.60 8 6 © 66 Sie 6 6 6 6 6 ee 6 8 0 ws & © Se) 6 ym al wie ie eee 


eco eoet tues eeeeecanevraetceeoCeueceecn en es Se ee eS 2 wo 6 0 0 6 0 6 0 8 6 6 6 6.6 @ SS oS 8 ele a) ei eee 


4 


eRe TeOleSIgiCOP © erst ocx AM binge ts Reka is Be oe keh ade whe} 


Do you have any impressions or sensations to report regarding the race? 


Deryou expect to wiun-the full distance agate is. Sikes lab ee et 
Meuse the Weimnt of Your running Siith <7). .6s. fos... Sonat ewe eae week 


Remarks. 


SLR Mee ese) SLO. Ve 8 6S) Sie b) © C'6e, O <0 (6 6S 8. -6\.6 8 8a. 18 0m 8 6 4 Le. oO Le Oe, @ ie 8) a ee se oo se Oe eee ee te 8 ee 8 & 
Cae eee ee BAe) 8 6: 8S, 6) a6 (Bie a Te 6 Ge (erieng, @ 6 4 ae ee Oo ee Oe yee 6 Gh eae Bera 6 Wee a wl Be Sw Eee 8 ee et 8 8 Se ce fe 
a ee oe eee NS. © se 6 658 + 6 o 61 8 S68. 6 0m ote 6 4:6 6. '6. 0.0.16, :9 6 8 6S 6.6 6 sie if eis 8 6 wee. 00 6) oe ele. 08 ee 0. @ 


eis, @ 2 ee #6 be Ae 6 OF HC RR ERR BOK OSS BROT HEH DK RCC MA MDH DO SDRC eae eC eee eee Cw Oe ee oe 8 


GENERAL SCHEME OF THE MEDICAL EXAMINATIONS. 


Having entirely within our power the making of the rules of 
the contest and the enforcing of them, we were enabled to control 
the runners, as has not been possible in previous observations. 
The usual course, 25 miles into the country and a run back, make 
it necessary to find limited quarters in which to examine the run- 
ners in the midst of excitement, confusion and noise, and then to 
transfer the examiners together with their instruments, over a 
distance of 25 miles to the finish. It is impossible this way to 
undertake certain desired records. We therefore planned a 
course, that should start from the club house, and pass this point 
four times, finishing at the starting point. This proved of ex- 
ceeding value, as will be shown later. 

The first circuit of the course was 3 miles, second circuit 8 
miles, the third, 12.5 miles, and the fourth 1.35 miles, making the 
total distance 24.85 miles, the actual distance from the battlefield 
at Marathon to Athens. 

Desiring to have some accurate heart and diaphragm measure- 
' ments, arrangements were made at the West Penn Hospital where 
they have a very complete equipment for the making of fluoro- 
scopic studies. 

A letter was sent to all intended competitors, taking them into 
our confidence and telling them what we wanted to do, and ask- 
ing for volunteers to report on Friday before the race for pre- 
liminary examinations; which examinations were much more ex- 
tensive and complete than was possible on the morning of the race. 
Twenty-four men reported, and of this number 22 were taken to 
the hospital and placed before the X-Ray. On the morning of 


Hy) 


the race, all contestants were ordered in at 11 o’clock and with 
the entire staff of assisting physicians present, thirteen in all, 
and three sets of instruments, we were able to get a thorough 
examination of all the starters, but, of course, could not under- 
take to send all of them to the hospital for X-Ray. examinations, 
feeling that it was better that we should have a few thoroughly 
done than to undertake something that would prove a failure, 
because of its being more than we could accomplish. 

As the men finished the race, those who had on the previous 
day been before the X-Ray machine, were immediately exam- 
ined in the tents and put into an automobile and carried to the 
hospital for a second examination, which was usually accom- 
plished in from fifteen minutes to an hour after the finish. 

The tents that were erected, for dressing and for the examina- 
tions, were arranged in a group in which the dressing tents faced 
the large medical tent. This arrangement brought all the men 
together before the race, where their change of clothing, prac- 
tically in the presence of the physicians, compelled them to come 
back to the same place for their clothing whether they completed 
the full distance or not. Here was a valuable factor, enabling us 
to examine very soon after quitting the run, those who did not 
finish the distance, affording an opportunity to make some of 
the most valuable observations in comparing the effect of run- 
ning upon a man when in condition, and when not properly pre- 
pared for the run. 

The running of the course in circles brought them back four 
‘times within easy distance of the examining tents, so that we were 
-able to get those who quit under observation soon after their 
exertion had ceased, although in one or two cases they had to be 
brought in by automobile attendants. The arrangement of the 
tents also avoided confusion and noise. 

The next important move was to offer prizes to all who finished 
within four hours, the condition being that they must pass both 
medical examinations, namely, before the race and after they 
had finished, otherwise, they could not qualify for a prize. This 
was the key which practically opened the door to the more com- 
plete series of observations that we were able to make, the conse- 
quence of which was as follows: Fifty-nine men entered for the 
run, one was disqualified before the race, 55 started; 29 com- 
pleted the full distance ; 20 failed to finish, but were examined by 
the physicians after their race and only six, most of whom did 
not complete, slipped by the examiners. 


THE COURSE. 


In studying the course as shown in the chart it will be seen 
that it is a very hilly one and different from the usual Marathon 


6 


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Miles Run O 


COURSE WITH ELEVATIONS. 


DIAGRAM OF THE 


courses which are laid out along some road leading to a city. The 
roads upon which many of the prominent Marathon runs have 
been held, are more nearly level-or slightly down grade. 

In this instance the hilly roads and the heavy downpour of 
rain, making asphalt pavements on a down grade treacherously 
slippery during the shower,delayed the runners, by making their 
task more difficult and lessening their rate of speed. 

The chart clearly shows that the men fell out after climbing 
the hills at the fourth to seventh miles, at the eleven and one half 
to fourteenth miles, and after the sixteenth to seventeenth miles. 

At the first climb, a total of 510 feet, seven of the runners seem 
to have become discouraged and quit when they reached the club 
house. 7 

The second severe climb occurred at the twelfth to the four- 


teenth miles, a lift of 310 feet. Here six others came to grief. 


At the sixteenth to seventeenth mile four more gave up. The 
others finished, but some of them came in after the time limit, 
having walked some of the distance. 


WEATHER CONDITIONS. 


The weather report of June 26 was taken about three miles 
away and is herewith shown: 


The barometric pressure from 2 p.m. to 6 p.m. averaged 29.13 inches, 
elevation 842 feet. A thunderstorm occurred from 1.10 p.m. to 3 p.m., 
advancing from the west. It was accompanied by a light rain in the 
downtown district of Pittsburg from 2.15 p.m. to 3.40 p.m., the amount 
of precipitation being 0.01 inch. The shower was moderately heavy, 
however, over Allegheny and some parts of Pittsburg. The hourly 
temperatures were as follows: 2 p.m., 82; 3 pm., 70; 4 pm. 71; 5 p.m., 
73; and 6 p.m., 75. The highest wind velocity during the four hours was 
19 miles per hour from the north during the 5 minutes ending at 2.50 
p.m. The total wind movement during the hour ending at 3 p.m. was 12 
miles; for the hour ending at 4 p.m., 6 miles; for the hour ending at 
5 p.m., 3 miles; and for the hour ending at 6 p.m., 3 miles. For the 
hour ending at 3 p.m., the prevailing. direction of the wind was from 
the north; at 4 p.m., northwest; at 5 p.m., west and at 6 p.m., southeast. 
The weather during the entire period was cloudy. We have no record 
of the humidity at those hours of the day, but it was probably higher than 
usual at those hours on account of the rain. Relative humidity at 8 a.m. 
was 73 per cent and at 8 p.m., 73 per cent.* 


Temperature 82 degrees F. at start of race; humidity 73 per 
cent. About an hour after the race began, there was a heavy 
downpour which lasted for about an hour and drenched the run- 
ners. This was the undoubted cause, directly or indirectly, of 
several quitting as a result of falls and sore feet. It may also 
have been a factor to be considered in the temperature findings 


- of those who did not finish the race. 


* Records from local office of the Weather Bureau, Pittsburg, Pa., submitted by 
Henry Pennywitt to Dr. Savage. 


7 


Wind varied from a velocity of 19 miles an hour to 3 miles 
at time of finish. | 


AGE. 


The ages of the contestants ranged from 18 to 52 years, with 
the major portion under 23 years of age. The under-age limit 
was placed at 18 years. The greatest number at any single age 
was 18, while more than half of the contestants were 22 or 
under. One man at 52, although he did not finish, still thinks he 
can run the distance. Success in finishing does not seem to be 
directly controlled by age; three at 36, one at 35, one at 31 
finished, while one at 52 and three at 29 failed. 


Ages of the first eight men were as follows: 22, 22, 20, 18, 28, 
Blk ooe Lue 


NUMBER QUITTING AND THOSE FINISHING THE RACE. 


Quit Age | Finished 


18 


= Bm WwW %wW WwW Cl 


) 
vo 
oO 


we 
ras) 
+1 


21 Total Cases 27 


Men past 40 should not try such long distance running, and 
the same holds true for those under 20. The most serious effects 
seem to have come to the man of 52 and to a boy of 18 years. 


HEIGHT OF RUNNERS. 


The general average of the entire series was 5 ft. 6.4 in., the 
greatest number being 5 ft. 7 in. The entire range varied from 
5 ft. 2 in. to 6 ft. 2 in. The large men showed up well, both 
in number of cases and position at finish. 


The first four men averaged 5 ft. 4 in., or 2.4 in. below general average. 
The second four men averaged 5 ft. 9 in. or 2.6 in. above general average. 
‘The third four men averaged 5 ft.5 in. or .9 in. below general average. 
‘The fourth four men averaged 5 ft. 7 in., or .3 in. above general average. 


rinight No. of Cases at Each Height 


Vk dbay 


ont oO oO FPF WO WD 


Total No. of cases, 50; average height, 5 ft. 
65 in.; mean, 5 ft. 6in. 


GiRTH MEASUREMENTS. 


The general run of the contestants showed better developed 
lower limbs than of the upper body as would be expected. 


Right army Ceti Sessa sake ve. dere average 10% in. 
Right Wali) Seto season | tee am eet average 13% in. 
Rightiiion <i. sete: a ea hanes average 19% in, 


GIRTH MEASUREMENTS. 


In. R. Arm || In. R. Calf In. R. Thigh 


1 | 12 18 
|} 122 1 181 1 
1 | 123/- 1 183|— 1 
123 1 183 1 
Serene 3 19 3 
4 | 183 6 192 2 
eee pes 3 Ave. || 19} 2 
oY" | 135 2 193 Pee, 
1 14 ees oe 5 
3 141 2 | 201 
3 141 204 2 
esate Ee 2 203 1 
| 15 || 21 
| 212 
215 1 
| 213 
| 22 1 
23 cases average 103 in. 23 cases average 138} in. 28 cases average 19? in. 


CHEST MEASUREMENTS. 


The chest measurements seem to be small for this class of 
men. The comparison of those who quit to those who finish show 
a definite advantage with the better chest capacity. 


Of the winners 7 were above average, 4 were below average. 
Of the quitters 5 were above average, 6 were below average. 


10 


WEIGHT. 


While the average weight of the entire series was 140 pounds, 
the greater number were below that. Compared with the insur- 
ance standard weight for their relative height, they were, on 
the average, 3.6 pounds below weight, 32 cases being below 
weight on the average of 9 pounds, and 18 cases above weight, 
averaging 514 pounds. In this last group there was one case 25 
pounds overweight which greatly influenced the general average. 


Lbs. 
Wt. 
115 
120 
125 
130 
135 
140 
145 
150 
155 
160 
165 
170 

175. 
180 


Number of cases 


Total No. of cases, 45; average weight, 140. 


OccCUPATION AND WoRKING Hours. 


The occupations, for the most part, were laborers, classed as 
light, medium and hard labor—coachmen, drivers, mill hands, 
etc; 

The working hours correspond to the investigations made by 
the Pittsburg Survey. The greatest number worked 9 hours and 
the average 94. 


ELVABITS. 


In the main, the habits of these men seemed to be good, and 
indicate the general understanding that one, to win such a race, 
must take care of himself and must be temperate. 


11 


The table shows coffee to be the almost universal drink; then 
comes tea, 20; only 8 use beer; 1 liquor and he finished in fifth 
place. There were 9 who took no stimulants of any kind. To- 
bacco is generally cut out; about one third only using in any form 
and then always moderately. Ten drank great quantities of 
fluid, over 3 quarts a day, but they were mill men who perspire 
freely when at work. Out of 28 finishing 11 used tobacco; 4 out. 
of the first 5 used tobacco. Of the 21 not finishing 8 used 
tobacco. 


INo. Working No. 
Occupation of Hours of 
Men Daily Men 
Professional 1 5 3 
64 1 
Merchants 3 8 a ee . 7 
| 84 1 
Clerks 5 9 10 
2 i: 
( Light "4 10 5 
104 6 
Laborers { Medium | 8 17 1 
| | 12 5 
| Heavy 10 13 
14 2 
15 
16 1 
Total No. of cases, 43; average hours, 93. 
HABIrTs. 
DRINKING ‘ 
Coffee 31 
Tea 20 
Beer 8 
Liquor 1 
Wine 0 
None 0 
TOBACCO 
Chew 4 
Cigars 2 
Cigarettes 2 
Stogies 
Pipes 7 


This was very interesting. Six were classed as vegetarians, 
one of whom was not permitted to run owing to a marked 
arrhythmia of pulse and generally poor condition. The other 5 
did not quite hold their own with the meat eaters, 60 per cent 
finishing. The greater number ate meat once a day, and of them 
65 per cent finished; out of the 10 who ate meat twice a day 70 
per cent completed the race. Beef was by far the most popular 
meat. 


DIET. 
Meat No. started. No. finished. pthc te 

0 5 604 
Week - 2 1; 100% 
Week 5) 2 50% 
wie aah : aa 20) 65% 
Day 2 10 70% 
Day 3 6 6624% 

MEAT PREFERRED: 

Beef 21 
Veal 1] 
Pork 4 
Lamb 2 
Any 5) 


AGE OF BEGINNING TRAINING. 


The study of the age of beginning distance running and ap- 
parent ability to complete the distance shows the greatest per cent 
of failures in those who began training at eighteen or under. 
This may be due to their incomplete preparation, but more than 
likely it is due to the fact that their organs had not yet reached 
sufficient development at this time of their natural growth and 
maturing years to withstand so severe a strain as this form of 
sport demands. 


18 


AGE OF BEGINNING DISTANCE RUNNING. 


Finished 
1 
. 1 
2 4 
5 4 
1 ? 
3 2 
2 4 
1 1 
1 1 
1 2 
2 1 
1 
1 2 
2 
1 
1 
i 
1 
23 Total Cases 28 


DISTANCE RUN IN TRAINING. 


Miles 
2 2 

3 2 

5 3 

8 1 
12 3 
13 1 
18 1 


15 cases: average 7 miles. 


14 


DISTANCE RUN IN TRAINING. 
This question does not seem to have been well answered, for 


what reason we do not know. Only fifteen gave this informa- 
tion, and their average daily run was seven miles. 


WeEIGHT Lost IN TRAINING 


The general average was 6.4 pounds, one man losing as high as 
23 pounds, and another 15 pounds. Both of these were six-foot 


A LCLY: 
WEIGHT LosT IN TRAINING. 

Lbs. 
0 2 
1 1 
2 4 
, 3 6 
4 2 
c 5 4 
6 2 
: 7 4. 
8 5 
9 3 
10 3 
11 0 
: 12 2 
13 0 
14 0 
15 1 
0) 
0 
23 1 


40 cases; average 6,5; mean 6. 


WEIGHT COMPARED WITH STANDARD WEIGHT FOR HEIGHT. 
Fifty cases—average loss 3.6 lbs. 


f Below abs: Gas 
1 3 
2 3 aa 2 
4 Eo 1 1 
4, Voecrrecs 2 0 
1A pecan 2 3 
6 3 q 
7} 2 0 
oh) ee 1 3 
9 i) 0 
10; 1 1 
LWA | pomoeeem 2 0 
£4 pee 2 yi 
HOD peomeaee 2 

Total cases above weight, 18; 

14 3 average 53 lbs. 
1) pee 1 
Ee ieee 1 
PS em 1 


Total cases below weight, 32; 
average 9 lbs. 


NUMBER RUNNING PREv10US MARATHONS. 


Our information on this point is interesting. The fact is that 
it is a new sport in this vicinity and nearly all of the races in 
which these contestants had participated had been run within a 
year. There were only five out of the entire series who had not 
tried this distance before. 


14 had run once before. 
12 had run three times before. 


Success and failures seem about the same, as both average two 
runs. 


Never run 5 out of 6 finished. 
One run 9 out of 15 finished. 
Two runs 3 out of 8 finished. 


More than two 11 out of 20 finished. 

It would seem from this table that in this class of athletes the 
first run is the best and after they had run three times they either 
quit as failures or continue as the survivals of the fittest. How 
much is due to the effect of the severity of this form of athletics 
is an open question. It does seem that the race can injure and 
incapacitate the inexperienced runner. 


16 


NUMBER RUNNING PREVIOUS MARATHONS. 


mare aoairk © wor © 


Ca) 


Loss OF WEIGHT DURING THE RACE. 


Lbs. 

0 2 
4 | 

1 5 
14 5 
2 6 
24 2 
3 3 
34 5 
4 6 
44 3 
5 1 
54 2 
6 1 
63 1 
N 1 180 lbs. 
14 
8 


83 1 1%0 Ibs. 


Total number of cases, 42; average loss, 3.1 lbs. 
Men who lost most were overweight, or large men. 


17 


Loss OF WEIGHT DURING THE RACE. 


It was difficult to get this accurately, as the rain had soaked be 
their clothing, and there was also a large variation in the weight 
of clothing worn. We tried to get it from the answer to the 
question regarding the weight of suit in the questionnaire, and ‘Ns 
then to allow for the amount of moisture it contained, but it. 
seems that the question was not accurately answered in all cases. 
The table shows a variation from nothing to 8.5 pounds, with 
an average of 3.1 pounds, the greater losses occurring in the 
large men who weighed 170 and 180 pounds. 
Some ate and several drank during the race, thus aie influenc- 
ing the body weight. 


TEMPERATURE. 


The observations upon the temperature proved a very interest- 
ing study, but unfortunately we cannot calculate the influence 
of the rain upon the runners, especially upon those who quit soon 
after the rain. 


DEGREES MOUTH TEMPERATURE 


MOUTH TEMPERATURE BEFORE AND AFTER RACE. 


The comparison between the mouth temperature and the rec- 
tum proves conclusively that observations taken in the mouth 
after running are absolutely worthless. You will see by the chart 
that these observations showed an average falling off in temper- 
ature of 14% degrees; whereas, it was fully expected and proved 


18 | F 


by the rectal temperature that this condition should be reversed 
and there should be a decided rise. 


Rectal Temperature. 


There was an unexpectedly wide range in these temperatures, 
from 97°46 degrees low to 104 degrees high. It is interesting to 
note that the man who finished with the highest temperature 
seemed to be in good condition at the finish, and said that he felt 
no distress after the seventeenth mile, and claimed to be a regular, 
and the only, drinker of liquor among the contestants; he had a 
systolic murmur at the finish which was not present at the start 
and he was the man who lost the second greatest amount of 
weight during the run. 


DEGREES RECTAL TEMPERATURE 


Weekes 


~“ 
eS 


ve) 


aa 
oe 
EM 
a 
oe 
ad 
Eh 


RECTAL TEMPERATURES BEFORE AND AFTER RACE. 
Each horizontal square represents one man. Each vertical square represents 1° F. 


The temperature of the winner was 10274 degrees at the finish. 
The variations of the temperature before the race were from 99 
degrees to 10144 degrees. The one who had the highest temper- 
ature quit the race at eleven miles, and when examined his tem- 
perature had fallen 2 degrees, which was sub-normal. Before 
the race we found the average temperature in these cases to be 


19 


10074 degrees; what there was present to cause such a variation in 
temperature before the race is hard to tell, unless it be the vary- 
ing element of nervous excitement; but there also seemed to be 
a corresponding variation in the temperature of the men after 
the race. We must, therefore, look to some other causes to ac- 
count for the temperature range. 

In undertaking to do this, we separated the quitters, those who 
did not complete the full distance, from those who were able to 
withstand the effort, as shown by their completing the distance, 
and a-very interesting observation is made, as you will see by 
the chart. The average temperature of those who quit was 99% 
degrees, while those who finished averaged at 101 degrees. 


DEGREES RECTAL TEMPERATURE 


27 |Cases f 
103 Average 101 / 
102 pte 
| 710 
11 Cas 
Pa 
100 


Upper Black Line shows Temperature of Men who Completed Race. 
Lower Dotted Line shows Temperature of Men who Fell Out. 


20 


We must not forget that these men finished soon after the hard 
rain, which may have reduced their temperature, and they did 
not have sufficient time to recover from it, but still, I am not dis- 
posed to accept this as sufficient to account for the marked fall 
in temperature; I am rather disposed to think that the fall of 
temperature was a registration associated with some physiologi- 
cal condition which caused the men to quit. Of those who fin- 
ished the average temperature was 101 degrees, ranging from 
98°£ degrees to 104 degrees. 

The men whose records throughout the entire series of tests 
seemed to be perfect, likewise finishing the race with very little 
variation in temperature, leads one to think that there is a con- 
dition possible for a man to attain that will enable him to par- 
ticipate in this game without undue disturbance in his functions. 

As will be seen from the X-Ray observation, the diaphragm 
assumes a much greater importance in the training of athletes for 
long distance running than has ever before been credited; it 
-seemed the first organ to fatigue and cause distress. It is pos- 
sible also that the lower temperatures of those who did not finish 
may be due to insufficient oxygenation, due to failure of the 
diaphragm. The hitherto unexplained pain commonly known as 
“stitch in the side,” is, I believe, located in the diaphragm; the 
probable cause being cramp of the muscle due to the sudden 
severe demand made upon this organ and the effort to meet the 

demand. 


General Conclusions. 


From the general deductions of these observations and from 
my study of those of the succeeding papers, it appears that the 
athlete most likely to withstand this form of severe exertion is 
one not under twenty and not over forty years of age. It is 
likely that he will be of less than average height and under- 
weight even for his height. He will have a light upper body, 
a relatively large chest capacity and well-developed legs. He 


armen 


must have a sound heart, healthy lungs and a well-developed | 
diaphragm; all of which have properly accommodated to the in- | 
creasing demands during the period of training. His training | 


should have continued over a period of from nine months to | 


three years. 

During his training he must be temperate in his habits, avoid- 
ing stimulants of all kinds, moderate in his diet, avoiding ex- 
tremes. He should work and exercise and sleep at regular hours, 
and of sleep he must have enough. The observations show 
clearly that the greatest injury comes to the man who is insuff- 
ciently trained, and that the successful running of this race is 
really beyond the realm of the average amateur athlete. 


21 


X-RAY EXAMINATIONS. 


JNO. W. BOYCE, M. D., AND GEORGE W. GRIER, M.-D.; ASSISEARaS 


D. E. SABLE, M. D., J. H. ALEXANDER, M. D. 


The X-Ray examinations were made in the fluoroscopic lab- 
oratory of the West Penn Hospital by Dr. Jno. W. Boyce and 
myself with the above-named assistants. 


Time of X-Ray Examinations. 


The examinations before the race were made on the preceding 
evening. Those after the race were made shortly after the time 
of finishing or as they dropped out. The only intervening time 
was that spent in making the blood pressure and cardiac obser- 
vations and the few minutes in the automobile to the hospital 
laboratory. 


Technique of the X-Ray Examination. 


The technique of each examination was exactly the same, so 
that the results of the several examinations on one man or of 
different men are comparable to each other. 

During these examinations the same tube was used in exactly 
the same position. The tube and its holder were fastened upon 
a board which could be moved up and down in a frame, as a 
window sash in a casement; no other movement of the tube was 
possible. Eighteen inches in front of the board which carried 
the tube was placed a canvas screen, seven feet long and two feet 
wide. This canvas was about twenty-three inches from the 
source of origin of the rays on the anode of the tube. 

This distance was constant, the canvas screen being fixed and 
the tube moving only in an up and down direction parallel to the 
face of the canvas, so that each man’s back as he stood with his 
nude body just touching the screen was at exactly the same dis- 
tance from the focus point on the tube. The tube was moved up 
or down until the anode was exactly level with the ensiform car- 
tilage of the chest. 


vo 
vo 


As it is absolutely essential for accurate fluoroscope work to 
have a perfectly dark room and for the investigator to stay in 
this room for some time before an examination begins so that his 
pupils will be properly dilated, it was impossible for the man 
making the tracings to leave the room until all men had been 
examined. All the tracings were made by Dr. G. W. Grier. 

The work of setting the tube and placing the patient was done 
by Dr. Sable, it being of course necessary to turn on the light in 
the room while this was being done. During the time the light 
was turned on, the examiner stood with closed eyes so that when 
the room was again darkened, his eyes were in condition to go on 
immediately with the next examination. 

Tracings of the man’s heart and of his diaphragm at rest and 
on deep inspiration were marked on his chest in blue pencil. This 
was done in the perfectly dark room as the man stood before the 
fluoroscopic screen. The permanent record was copied by an 
assistant, Dr. Sable, in an outer room. 

Twenty-three men reported for the first examination, fourteen 
returned immediately after the race and eleven returned in one 
week for the. final examination. 


Sise of the Hearts. 


In coinparing the hearts of these men the first and most obvious 
conclusion seemed to be their relative size. It is very difficult to 
say what the proper size for the heart of a certain individual 
should be, and whether at all there is such a thing ‘as a proper 
sized heart, as the size of the heart seems to be an effect of en- 
vironment. We have endeavored, therefore, to make an anatomi- 
cal classification rather than a physiological one. In doing this, 
we divided these hearts as to size, in four classes: small, medium, 
large and very large. Of the small hearts Figure 1 is a fair ex- 
ample; of the medium, Figure 2; of the large, Figure 3; and of 
the very large, Figure 4. Those that were classified as small 
hearts we are sure would be called unusually small, and the very 
larges ones, unusually large, by the average clinician. In fact, 
those classed as large hearts are, in my opinion, abnormally large 
and would surely be classed as pathological for a man of seden- 
tary occupation. Of 6 men with small hearts, none finished; of 
8 men with medium hearts, 4 finished; of ? men with large hearts, 
4 finished; and of 2 men with very large hearts, 2 finished. 

It is thus seen that of 9 men with hearts above the average 
size, 6 finished, 66274 per cent and that of 14 men whose hearts 
were not enlarged, only 4 finished, 2814 per cent. The conclusion 
to be drawn from this fact is obvious; that a successful Marathon 
runner must have a heart above the average size. 


23 


ena an 
Zp et 

= 

1H & + 

eer oo oe 
A, 4 


Os ° 
2788, 


Shape of the Heart Before Race. 


In regard to the shape of the hearts of these different men, it 
is very difficult to make satisfactory classifications, as no two 
hearts of the 23 examined are of exactly the same shape. How- 
ever, there were a sufficient number that followed two general 
shapes closely enough so that 1 think it may be of some value to 
note the results of these two groups. Eight of these 23 men had 
hearts which were placed almost vertically in the chest. Six of 
these 8 also had a heart below what might be considered as nor- 
mal in size. In short, they had the small vertical heart often 
mentioned as being found in tubercular or tubercularly predis- 
posed subjects. Of these 8 men with vertical hearts, none fin- 
ished; 100 per cent failure. Figure 1 is a fair example of the 
vertical heart. 

Six men presented the opposite extreme to a vertical heart, 
that is, a heart placed horizontally in the chest. Figure 3 is a 
fair example of this type of heart. Of these 6 men 5 finished, 
8314 per cent, the only man with this shaped heart not finishing 
being an old man 52 years of age. Of the 9 remaining whose 
hearts we examined there is no general shape to which these 
hearts could be said to conform. ° 

Figure 2 will serve, however, to show the contrast between 
these and the two preceding classifications. Of these 9 men 5 
finished, 5514 per cent. 

These findings then serve to confirm the conclusions made as 
- to the proper size for an athletic heart which is in all cases an 
unusually large heart and particularly a heart of large ventricles. 
The lack of reserve force of the men of the small vertical heart, 
we believe, has been substantiated by those investigators who 
have shown this type of heart to be an important predisposition 
to, or a concomitant of, pulmonary tuberculosis. 

In the X-Ray examination of a large number of tubercular 
subjects we have become firmly convinced of this fact and the 
failure of these men to finish the race seems an additional proof 
that a man with the small vertical heart should not attempt such 
violent exercise as a Marathon race. 


Shape of Heart After Race. 


Of the 14 men who presented themselves immediately after the 
race for examination, only 3 men had no enlargement of the heart 
over its size immediately before the race. Of these 3 men, 2 ran 
but 11 miles, and I think should not be further considered as they 
did not run far enough to be compared with the men that finished. 
The only man who did finish with no extra enlargement of the 
heart was No. 24, the tracing of whose heart is shown in Figure 
8. This man’s heart seems to us ideal in shape and size for an 


26 


athletic heart. He has been engaged in running for nine years, 
and is a well-trained athlete. His general condition at finish was 
excellent. 

The enlargement of the heart during the race in the majority 
of cases was symmetrical, as shown in Figure 5. Of the 14 men 
who returned after the race 9 showed an enlargement of all cham- 
bers of the heart, 1 showed an enlargement of the right heart 
only, and 1 showed an enlargement of the left heart only. Three 
men had no change in the size of the heart. These 3 have already 
been discussed. 


One Week After the Race. 


One week after the race, 11 men presented themselves for ex- 
amination and of these men, 2 still showed a heart of the same 
size as immediately after the race. Of these 2 men, one was 
the man 52 years of age who has been spoken of before as being 
too old to undertake such violent exercise. The other man show- 
ing a permanent enlargement of the heart following the race had 
a small, vertical heart which may have been in the process of 
acquiring the compensatory enlargement evidently necessary to 
all athletic hearts. The remaining 9 of the 11 men that pre- 
sented themselves one week after the race had hearts smaller 
than they were before the race. ‘This fact shows that these men 
in training for the race developed a temporary enlargement of 
the heart to provide for the additional work placed upon it dur- 
ing the race, and after the abnormal demands upon it ceased, the 
heart returned to its normal size. 


Observations Upon the Diaphragm. 


The changes of the diaphragm after the race were probably 
more striking even than those of the heart. Not only was there 
a decided change in the position and range of motion of the 
diaphragm after the race but there was also a decided difference 
in the two sides. On the right side in two cases the diaphragm 
occupied a higher position in the chest after the race, that is, it 
was not only higher in the chest while at rest, but also on deep in- 
spiration its position was higher in the chest than during the cor- 
responding phase of respiration before the race. In these two 
cases, the range of motion between the diaphragm at rest and 
on deep inspiration was less than before the race. 

In 6 cases on the right side the position of the diaphragm at 
rest was the same as before the race, but it did not descend so 
far upon deep inspiration, the range of motion being obviously 
less than before the race. In these 8 cases, therefore, the range 
of motion was less than before the race. In 3 cases the position 


27 


and range of motion was the same on the right side as it was 
before the race. On the left side the condition of affairs was 
practically reversed, in 8 cases the diaphragm being higher in 
the chest than it was before the race both at rest and on full in- 
spiration. However, there was not such a difference in the 
range of motion on the left side, and only 4 of the 8 cases had 
less range of motion than before the race, 2 having the same, and. 
2 having even a greater range of motion than before the race. 
‘In 2 cases on the left side the position was the same at rest as 
before the race, the diaphragm not descending so far in the chest 
on the full inspiration line. 

Of the 11 cases, therefore, on the left side, 6 had a less range 
of motion, 2 had the same and 3 had more than before the race. 
In these cases, I should say that the tendency seems to be after 
prolonged violent exercise for the diaphragm to occupy a higher 
position in the chest and to have a decidedly less range of motion 
than before, as shown in Figure 6. Three of these cases pre- 
sented an anomalous condition, which to my knowledge, has 
never been described before. In these cases the diaphragm on 
both sides did not descend on full inspiration and on urging the 
man to further efforts of inspiration, actually ascended into the 
chest, in one case flattening out at the same time. This 
action was undoubtedly due to the fatigue of the diaphragm, but 
why that complex and always very interesting organ should 
present this particular phenomenon, and the method of its pro- 
duction, I have so far been unable to determine. 


TABLE SHOWING PER CENT WHO FINISHED WITH REFERENCE TO SIZE 
OF HEART. 


Small | Medium | Large Very Large 


| | 
0 per cent 950 per cent | 7 per cent |100 per cent 


2814 per cent | 6624 per cent 


28 


PHYSIOLOGICAL AND PATHOLOGICAL EFFECTS ON THE 
CIRCULATORY AND RENAL SYSTEMS.+ 


JOSEPH H. BARACH, M. D., ASSISTED BY DR, C. L. PALMER, DR. F. D. 
STOLZENBACH, DR. H. G. WERTHEIMER. 


The extreme importance of the role played by the circulatory 
system in severe and prolonged exertion need hardly be empha- 
sized here. It may be said, in fact, that the circulatory system 
bears the brunt of the effort, and its condition, therefore, deter- 
mines to a very great degree the success or failure of the con- 
testant. The following observations upon fifty-five contestants 
were made in the order which they are here presented: 


PULSE RATE DuRING TRAINING. 


At some time during the week before the run we had the con- 
testants count their pulse in the morning before getting out of 
bed and in the evening before retiring. They all ran their train- 
ing distance on that day, which varied from 2 to 18 miles, the 
average being 7. 

Table 1 shows the morning pulse to have been below 71 in 13 
out of 16 cases, and the evening pulse was below 71 in 10 
out of 16 cases. Taken as a whole, the pulse rate is a little slower 
than what is considered normal for the average individual. 


TasBLe 1. MorNING AND EVENING PULSE DURING TRAINING 


MORNING PULSE. EVENING PULSE. 
Cases. Cases. 
AQ DORR aa tate rea ruins 1 A= Ee are teard evade tiers os 0 
DOZOGOR Get nae ersten s ayn cies 6 BOGOR SSS rect cles oes 2 
COS 70 er) Nei ee icc aes 6 GOSCORs sa rate fe cae oe eae 8 
LOL OO ease eineaae te «odie 3 OSBO0 eee eee sa Shanes 6 
16 16 


RELATION OF MORNING AND EVENING PULSE. 


I noticed that in about half of the number there was a marked 
difference between the morning and evening pulse rate. In Table 
2% these cases are separated in two groups. A further study 
brought out the interesting fact that those subjects who showed 


*Presented by invitation before the American Physiological Society at the Harvard 
Medical School December 30, 1909, Boston. 


29 


the greater diurnal variation had higher blood pressures. And 
there was but one subject that showed high blood pressure who 
did not have this marked diurnal variation. 

The subjects in the second group are further advanced in life 
than those of the first group and a higher blood pressure is to 
be expected; nevertheless, as will be seen later, these readings 
are higher than they should be, all things considered. 


TABLE 2. MorNING AND EVENING PULSE DuRING TRAINING. 


NORMAL VARIATION. HYPERNORMAL VARIATION. 
= 1ise—— —=Paise—_—— 

Age. A.M. P.M. BP: Ase... -A-M> «7PM: BAP: 
18 %2 68 110 20 52 53 140* 
19 58 58 118 21 60 ve 135 
19 54 64 120 25 50 vi 150 
22 60 65 125 29 60 7 162 
22 vi és 125 31 48 7 138 
29 64 66 115 36 5d 65 182 
29 60 62 122 36 70 fe 140 
29 65 71 120 52 5 68 134 


* Exceptional case. 


PuLSE RATE BEFORE THE RACE. 


The pulse rate was taken in the horizontal position in all cases 
before the race, half of them on the preceding evening and the 
others in the forenoon within three hours before the race. So 
far as could be estimated, the psychic influence of our investiga- 
_tions on these contestants at this time was not a considerable 
factor, as we made an effort to put them at ease so as to eliminate, 
if possible, such influence on the pulse-rate and blood-pressure 
readings. Table 3 shows that, while the pulse varied from 50 to 
110, in most cases it was normal. 


TABLE 3. Putse RATE BeEForRE RACE. 


No. Cases. Pulse Rate. No. Cases. Pulse Rate. 
pat BI Be amas 2 50-55 100%: caceackoes 80— 85t 
Oreo eee eres 55-60* b Cie OR eect eae 85- 
/ RAED ig eae 60-65* Dis eee Sere 90- 95 
Jigs eee ae 635-70* D Se ee eee 95-100 
Qe shee hice bee 70-75* 1 eee 100-105 
Sie ess hiss ee 75-80t DS eae cae eee 105-110 


Total number of cases, 55. 
* Pulse rate 55 to 75, 27 cases. + Pulse rate 75 to 85, 18 cases. 


BLoop PRESSURE STUDIES. 


These records were made with the Erlanger and the Stanton 
sphygmomanometers. They were both fitted with the same width 
rubber cuff (10 cm.) and had been previously tested and com- 
pared. All the work referred to in this paper was performed 
with the instruments used in these observations. 


30 


Before the race we obtained complete records made with the 
Erlanger instrument in 24 cases and with the Stanton in 21. No 
attempt was made at reading the diastolic pressure with the Stan- 
ton instrument. 


NORMAL BLoop PRESSURE. 


As a basis for comparison in this series a curve was constructed 
based on 90 blood-pressure observations in normal males at the 
succeeding years. This is shown in Chart 1 and the succeeding 
charts of averages. Of the individuals of 60 and over, while it 
may be said that they should not be considered normal on account 
of the changes that are invariably present at that age, yet I can 
affirm that they were distinctly free from marked evidences of 
disease. 

It will be noted that with the advance of years the curve grad- 
ually tends upward. This seems in accordance with the fact that 
the heart enlarges as the age of the individual progresses. 

With this line as a normal level of the maximum blood pres- 
sure, in all of my observations in the past, I have found that a 
variation of more than 25 mm. above or below is usually asso- 
ciated with evidence of disease. 


MAXIMUM BLoop PRESSURE BEFORE RACE. - 


These determinations were made with the Erlanger instrument 
eighteen hours before the race in 24 cases, and with the Stanton 
two hours before the race in the other 29 of the series. The aver- 
age maximum blood pressure of the entire series of 53 cases was 
126.5 mm. 

The average maximum of these cases, arranged according to 
the age, is shown in Table 4, which shows the constancy and regu- 
larity with which the blood pressure rises as age advances. 


TABLE 4. AVERAGE MAx1iMuM Btoop PRESSURE BEFORE RACE IN 45 CASES. 


No. Cases. Age. Average Maximum B.-P. 
12 18-20 122.75 
20 20-25 125.05 
11 25-30 129.00 
2 30-35 136.00 


The average maximum, minimum and pulse pressures of these 
contestants, first in the horizontal and then in the erect position 
of the body, is to be seen in Table 5. These cases are arranged 
in the order in which the contestants finished in the race. As is 
well known, the change of the body posture causes certain altera- 
tions in the relation of the pulse and blood pressures. These are 
noted in the last column of the table as plus, minus and equal. 
The conclusions from these will be commented on later. 


ol 


TABLE 5. Brioop PRESSURES BEFORE THE RACE IN HorIZONTAL AND ERECT 


—_—__—_-_—__. Horizontal ——— ——_——_ 
-——-B. -P.—_——__ 
DF. &P:=P-Pulsex us. Doe Pee 


No. Age. Pulse. S. 


4 18 
5 28 
v4 36 
11 19 
12 21 
13 22 
15 19 
¢ 23 
19 7 
22 21 
24 7 
7 19 
30 25 
32 52 
38 21 
39 19 
40 23 
41 ? 
43 20 
7 29 
48 27 
49 7 
50 21 
51 18 
Average 


TABLE 6. MAxIMUM, 


G2 110 
105 132 
63 132 
7 120 
76 145 
74 125 
84 110 
106 135 
66 122 
80 130 
67 120 
54 118 
65 110 
82 134 
69 124 
7 155 
66 133 
64 130 
75 120 
83 162 
62 130 
7 130 
70 105 
76 118 
74.8 127.8 


POSTURES. 


MINIMUM AND PULSE 
ACCORDING TO AGE. 


-—_———— Hrect, ——___—_ 


ee) 
AS 
wW 
io) 
wz 
o 
o 

Wy ; 

' 

i 


ich Eu Tis 4 ited ac este ie ae 


rea florets bee DASE betel tcta iad ets 6 


rs 
PWV -RE ) E E 444-+ I +4441 11 
pac ieee pag ae en aia ae ieee 


| 

1+ | 
oO he 
Woit 
wots 
oi+ 
Co Oo 
Woi+ 
w Ro 


PRESSURE BEFORE RACE 


HORIZONTAL. 

—Age 18 to 20— —Age 20 to 25— —Age 25 to 30— —Age 35 to 40— 
Max. Min. P:-P. Max. ~Min. P -P, Max. “Min> P:-P)) Max Mineo 
110 90 20 145 100 45 132 98 34 132 100 32 
120 85 35 125 100 25 122 90 32 ae aes oe 

110 90 20 135 90 45 120 95 25 

118 92 26 130 109 30 110 90 20 

155 130. “25 124 95 29 162 112 50 

118 95 23 133 110 23 130 100 30 Ar see 

ae ti 120 88 32 130 95 35 AGE 52 

ee AR 105 85 20 ao: a 3 134 100 34 

Average: 
121.8 97. 248 12338 96. 31. 129. 98. 382. 
ERECT 

115 80 35 145 100) P45 128 day BSE 132 100 32 
' 120 80 40 122 100 22 118 90 28 Ae vt ae 

118 85 33 135 100 35 139 100 30 

112 92 20 132 100 86. 22 112 98 14 

igo a 120 100 =0 150 105 45 

142 118 24 Kp re 

om ma 135 100 35 120 100 20 

110 95 15 as a nae Sed =F 

eas oF 100 80 Palio By: 100. 32 AGE 52 

ae Save 110 85 25 “ 138 100 38 

Average: 
11955 916 | 27:8 28.8 


124.8 95.6 28. 127. + 98.2 


ao 


oe 


= 


THae 
el I6 


=x 
fal 
res 
Pa 
pas 
Le | 
ze] 
a 
fer | 
(ai 
=a 


TTT TTT TTT 
A 
TTT 
PORE RRRER GRRE ACE 
TTT TT eey 
BURR RES RL AURORE 


Ae 
a Be aa 
Sere ees 
ileal 
eS Es Ba 
Gage baa 
Ea tt at 
ba BS 
Rat A ETS 
Balbo 
Mit fa 
ee pee 
oa 
ai eee 

Pat as 
Le eet 
Bees So 
ia 


Fig. 1.—Average maximum blood pressure (before the race) of contestants 
Cine A-A) compared with average maximum blood pressure in 90 normal men 
Cine N-N). 


On the maximum blood pressures in all the subjects at their 
respective ages I have constructed the chart shown in Figure 1, 
and it is to be noted that this curve is at about the upper limit of 
the normal blood-pressure zone. 


RELATION OF Bopy WEIGHT To BLoop PRESSURE. 
Table 7 shows that half of the overweighted subjects and a 
little over a third of the underweighted subjects had higher than 


average blood pressure. Between the degree of overweight and 
the height of the blood pressure there was no relation whatever. 


TABLE 7. RELATION OF Bopy WEIGHT TO BLOoD-PRESSURE. 


53 CASES. 

: Cases. Hypertension. 
Mirycl @ rerun tte perc crete oretetete etele relates c/enicec 34 10 
CIVER Wel Siete eae we viasan ee ames habee 16 8 
INRopoieavelilte 5 Cet cho aOR Oia Bric 3 0 


RELATION OF OCCUPATION TO BLoopD PRESSURE. 


The occupations were subdivided according to the amount of 
physical strain. Only those were classified with the hypertension 
cases whose pressures were distinctly above the average for the 
age of the subjects. 


TABLE 8. RELATION OF OCCUPATION TO BLOoD PRESSURE. 


B.-P. Average, B.-P. Above Average. 
PTULESSIOMAY avi dats ciety dae kck Pee sce 2 1 ° 
REMC Ne etnies rain aes coe ae ashe Uae ve {( 1 
Papeete AMON dp alec dates k eee se oe Me 6 2 
Tet MrRERT ohn eet 15 4 
ELS Wave EL LI Tetras ois. oui aw Fane ver connate 9 13 


RELATION OF PREVIOUS MARATHON RuNS TO BLOOD PRESSURE. 


Some of the contestants were experienced long-distance run- 
ners, but most of them had partaken in long-distance races not 
more than one year; so that the extra strain thrown on the circu- 


latory system was rather sudden and in some instances was per- 


sistent during the entire year or less. 

Table 9 shows the number of races run and the time of long- 
distance running. The runners showing high blood pressure are 
in those who had trained for and run from three to five races 
within the first year of their experience. The experienced run- 
ners of nine, ten, eleven and twenty years all had average blood 
pressures. 


TABLE 9, Previous RUNS AND BLoop PRESSURE. 


Years Long Dis. Run, Marathon Races. Blood Pressure. 
Average 
Average 
Average 
Average 
Average 
High 
High 
High 
Average 
High 
High 
Average 
Average 
Average 
Average 


9° 


TO OF OY OO OY OO HA HR OL OTOUR Co 09 OD 


be eh ed RD 


HEART CASES. 


Auscultation was carried out in every one of the 55 contestants, 
within twenty-four hours before the race, with abnormal findings 
in seven cases, as shown in Table 10. 


TABLE 10. Heart CASES. 


Cases. 
Systolicsmurmnr at APES... vc cvssek seis cee scar ote ean PEED ae eee a 
Systolic murmur at prlmonic\area a.k.a nee aaron stale ees A! 
Muted sirst. Sound atia pexs.. ioscan eicls rea visite canteen emia 1 
ADED y EMA eae he Meisraters clotcteroalergrciele eheteyois ie meraiae auc efey a tate male oes 1 


On inspection, a considerable number showed very prominent 
apex beat, and in nearly all cases the impulse was plainly visible. 
Percussion was not carried out, as the presence of hypertrophy 
was to be determined by a more accurate method. 


BLoop PRESSURE IN HEART-MURMUR CASES. 


In each of the five murmur cases there was a maximum and 
minimum pressure distinctly above the normal line, and four of 
them showed a pressure very much higher than the average 
height. 


34 


or 9 cs 


U 


ed 


Table 11 gives the readings in these cases, and Figure 2 shows 
their maximum blood pressure as compared with the other ath- 
letes and normal individuals. 


TABLE 11. HEART-MuRMUR CASES. 


Age. Max. Blood Pressure. Min. Blood Pressure. 
18 110 90 
19 155 130 
21 140 100 
29 162 112 
36 132 110 


Baie BAT Beat 
SScssScsa5525 SSeSSe5S=27e 


Fig. 2.— Average maximum blood pressure (line H-H) of five contestants with 
heart murmurs (before the race) compared with average maximum blood pressure 
of other contestants (line A-A) and of normal men (line N-N). 


RELATION OF HEART CASES TO Bopy WEfGHT. 


Having learned that in these cases there was no history of 
cardiac involvement from disease, I thought it might be of in- 
terest to search for other causative factors. We have studied the 
age, height and weight of these contestants and classified them as 
over, under and normal weight. The relation of these heart 
cases to the body weight is shown in Table 12. 


TABLE 12. Bopy Weicut In Heart CASsEs. 


BEFORE RACE. AFTER RACE. 
Heart. Weight.* Heart. Weight. 
FOCCHIMITCCTIL sian ses ers = Intermittent aeetece - 
DY SUA PO Rg cto euler rete N OY StasbaSee, wanstenhcs soe a 
OV She PEXieacnsiele sete — DVS Pack PO Nee date meme acer N 
SY SE BUA POR aes 'h wise accele _ SVSEwA Pexes evsieciess _ 
WYViSti A POs pss itaree oo cite ale a LTT OO ia. Wasnretaes cis esisatteeie - 
REY Shey ALTO IC Hie an a 4 are + 
JG cla gig Bin capt2h emote aoe - 
*In this column + means overweight; —, underweight, and N, normal. 


The table shows that the murmurs were entirely independent 
of body overweight, and that the proportion of underweight cases 
is about the same as in the entire series. 


do 


BLtoop PRESSURE AFTER THE RACE. 


The blood-pressure readings were made immediately after the 
finish in nearly every case. In only a few instances was it de- 
layed four or five minutes after entrance to the medical tent. For 
comparison, the readings obtained before the race are repeated 
in the following tables. The average of the maximum pressures 
before the race was 126.5 (53 cases) and 107.3 (38 cases) after 
the race. 

Table 13 gives the readings in the individual cases after the 
race and the average pulse rate, maximum, minimum and pulse 
pressures, in the horizontal and erect postures. The effects re- 
sulting from the change of posture are to be noted in the last 
column. » 


Tasce 13. Purse RATE AND BLoop PRESSURE IN HORIZONTAL AND ERECT 
PosTuRES AFTER THE RACE. 


——- ————- Erect -—_—— 


—_—___—_—_ Horizontal 
———B.-P.—_—— —___—_ 3 -- Pp. ———— Result. 

No. Age. Pulse. S. D2 P:=PS Pulses. Dies? eee S. Dawee--: 
4 18 93 95 88 i 112 98 90 8 -- “= — -— 
5 28 120 95 80 15 138 90 ? ? a — A age 
% 36 112 88 ? a 120 88 ? a + = F ne 
11 19 112 100 vi 30 112 108 "5 33 = a= — — 
12 21 100 108 80 28 108 100 80 20 a — = = 
13 22 96 94 74 20 100 92 80 12 + — a = 
15 18 104 105 80 25 120 110 75 35 _ + — — 
ft 23 106 100 80 20 116 88 7 13 — = = — 
19 fi O38 110 85 25 114 100 85 15 + as = a 
22 21 90 100 82 18 96 85 70 15 a — — — 
24 27 80 110 fs 38 93 105 80 25 — — —— — 
vi 19 80 114 90 24 116 108 90 18 _ = = = 
30 25 81 110 95 15 96 110 92 18 oe = = + 
32 52 106 118 92 26 129 108 90 18 = — = _ 
38 21 81 80 75 5 99 95 80 15 —_ a a - 
39 19 108 92 vi 14 120 82 4 10 _ = — -- 
40 23 114 108 88 20 135 108 88 20 + aa = = 
41 ? 60 122 88 34 81 130 100 30 =~ _ _ 
43 20 92 120 88 32 110 100 80 20 - _ _ — 
+19 +5 +6 +5 
= 1. —129) = se—12 
Average 95.6 108.6 82.5 22. 111.3. 100:;2' (82:4 19:1 — 330s 


The averages of the readings after the race (Table 13), as 
compared with the findings previous to the race, are shown in 
Table 14. 


Taste 14. Purse Rate, Maximum, MINIMUM AND PULSE PRESSURE, 
BEFORE AND AFTER THE RACE. 


———_Horizontal Erect — 
Cases. Pulse. Max: Min: P.-P>) Pulse, 9“Max.) Mine 
Before sa. cers. 24 74.8 127.8 96.7 30.3 78.3 124.0 95.9 29.3 
DTtCTees cen ceee 19 95.6 103.6 82.5 22.0 eS 100.2 82.4 19.1 
36 


-_~, 


, 


we 


th) 
oe 


Arranged according to age, the individual readings are to be 
seen in Table 15. 


Taste 15. Maximum, Minimum AND PuLse PRESSURE AFTER 
ACCORDING TO AGE OF SUBJECTS. 


RACE, 


HORIZONTAL. 
—Age 18 to 20— —Age20to2%5— —Age 2%to30— —Age 35 to 40— 
Max. Min. P:-P: Max. Min. P.-P: Max. Min. P.-P. Max. Min. P.-P. 

95 88 u 108 80 28 95 80 15 88 ? ? 
100 {i 30 94 i 20 110 85 25 Ac ws . 
105 80 25 100 80 20 110 72 38 F 
114 90 24 100 82 18 110 95 15 ; 

de ae Ae) 80 75 5 eas ote ws aA 

92 78 14 me ar es + 

beh os we 108 88 20 AGE 52 

S36 120 88 32 118 92 26 

Average: 
O12 81:25 20. 101-4 Si. 20:4 106.2 838. 23.2 
ERECT. 

98 90 8 100 80 20 90 ? ? 88 ? ? 
108 75 33 92 80 12 100 85 15 a i 

110 « 35 ae i es ‘ee Ag is ne ie 

ahd sie ir 85 70 15 110 92 18 at 

108 90 18 Bie BA a are st af an 

ers oa - 95 80 15 ie ae 

82 70 10 ess a af Se 

vis sc ae 108 88 20 AGE 52 

ar 100 80 20 108 90 18 

Average: 
101.2 80.4 20.8 95.4 79. 164 101.1 85.6 19.3 


The chart shown in Figure 3 is based on the readings obtained 
immediately after the race. It shows the normal curve, the curve 
based on the average of all the cases after the race, and the blood- 
pressure readings in the murmur cases. It will be noted that the 
total average curve is now below the normal line, whereas before 
the race it was about 25 mm. above the line. It will also be noted 
that the murmur cases suffered a greater fall than the others. 


Fig. 3.—Average maximum blood pressure after the race in the contestants with 
heart murmurs (line H-H) and in all contestants (line A-A) compared with normal 
curve (dine N-N). 


37 


HEART CASES IN THE RACE. 


Of the 5 runners who had murmurs before the race, 4 ran the 
full distance and one ran nineteen miles. Three of these were 
among the first 12 to finish the race. These runners were all new 
to long-distance running. 


After the race the hearts were auscultated in the first 45 as they 
finished. Out of the 29 that finished within the time limit (four 
hours, fifteen minutes) 5 presented heart conditions. Table 16 
shows the place in which they finished. The fourth column in 
Table 16 shows the proportion of the pulse pressure after the 
race to that before. 


TABLE 16. Purse PRESSURE BEFORE AND AFTER THE RACE IN RUNNERS 
WITH HEART SYMPTOMS. 


Pulse Pressure. 


Finished. Before Race. After Race After. Before. 
AAS eres Muffied apex first Intermittent and weak 

+ Le ee ah SE O Systolic base ae 4F 
ACD oon << Systolic apex Systolic apex a 20 
Sthisnw cen O Systolic apex 15s 34 
(theses Systolic apex O re 32 
Sth ceaeek Systolic pulmonic O 20: 45 
29th. shes. O Irregular ci ss 
Sabie mare Systolic apex O 10: 29 
SED oc steters Systolic apex Not examined “% ee 
SOC. alee Arrhythmia Not examined 


These “heart subjects” had more'rapid pulses and smaller pulse 
pressures as a result of the exertion. Their blood pressures are 
shown in the charts, Figures 2 and 3. 


BLoop PRESSURE TEN DAys SUBSEQUENT TO THE RACE. 


At this time we find the blood pressure about the same as 
before the race, or, rather, it was nearer the normal line than 
before. 


TABLE 17. AvERAGE Max1tMuM BL toop-PressurE BeEForeE, IMMEDIATELY 
AFTER, AND TEN Days SUBSEQUENT TO THE RACE. 


Cases 
BElOre 02. Avram ismetaee akties Wearsen aces 126.5 53 
Immediately arteries 2 ih.ad. sickle cee ociea 107.3 38 
‘Petidays SUDSEQUEDL oe ones gence 124.7 19 


Table 18 shows the average pulse rate, maximum and mini- 
mum, and pulse pressures in the horizontal and erect postures, 
as compared with the tables of the same data before and after. 


38 ; 


3/ 


Taste 18. AveraceE Maximum, MINIMUM AND PULSE PreEsSURES TEN 
Days SUBSEQUENT TO RACE. 


—-——-Horizontal——_-———_ -—_- Erect —- 

NowCasess Pulses “Max, Min; ~P:-P. ~Pulse ~Max. Min. P.-P. 

Sages, SARS 24. 74.8 127.8 96.7 30.3 48.3 124.0 95.9 29.3 
Immediately after....... 19 95.6 103.6 82.5 22.0 111.3 100.2 82.4 19.1 
feneaays subsequent... 17% 61.8. 1247 92.1 33.7 68.2 125.1 93.2 31.2 


The readings in the individual cases are to be seen in Table 19, 
and these cases, arranged according to age of subjects, are given 
in Table 20. 


Taste 19. InpivinvAL Maximums, MINIMUMS AND PULSE PRESSURES TEN 
Days SUBSEQUENT TO RACE, 


SUBSEQUENT. 
—-———- Horizontal -—————_ Erect 
Bi ee ened Result. 

No. Age. Pulse. S. Di.P:-PePulse. ss: Dee P <P oP; Ss. Dee: 
418 50,” 125 88 Cae 5207 130 Don Be gree he ere 
Beers 7 119 90 - 29 8) 120 DOs SSI ek Mir wee ae ee ie 
merse, 64.124 BPO wry TIS S100: AB et) Me ko 
pte ETO 62, >.2"F20 Commits Gn ee 180s 1005)” BO an rece te Oc 
Pee ois. Gor, 159) 1007. be? 150. TOO | ob ASE) Gee? aa) Joe 
pod.” 63 2) 110 q 35 66 110 EMSA: Wap eae cae an) RN i 
foe 18252) 1120 95 25 -% 122 OF Ou are este, 8 wee 8 
ie 23. ° 938.9 118 80 388 90 120 Offeee SOP a ™ oe Wl ee 
eeon p48 1180), 100.80: ! 58). 138 oe US cok ela oe a ae an 
Ba s8i.- (72. 188 909 48 90 128 Ge ie ANN SS cle Miia ate 
7 VS ne: 1209) VG02= B08 120 ON iy 30") cet! |) ee pee 
ew 219 GB) 185 88 fr 84 F190 CES Be apayaae 2 2S Sale | nee 
ie ob, 5G 119 92°920' .-.BB- ° 119 Os OY “its SSN ekg kt ee 
See ot Shen e144 wer iD predte! 64-6 155. 110. 4B ee a es 
Boe 9) 56 + 110 BAe OF. 7590110 if oa emene 9 1  aenagey fF) 3% 
MGeeoS. 462) ©1962 100%) 25° 266") 182. 100 Bk Ciel Meare bee es ype 
20) |: BG) = 5 118 S84. 90" 66. 110 OUP BOQ abe Pf | nee 
$1448 4° 8 +6 
Bt pea An, eae 
Seed O- aa Olga t24 7a Oe.) micas 66.21 iie0.1, 03.2 81.2= 1, = 5) 6 = 3 

TasBLeE 20. Pressure READINGS TEN Days SuBSEQUENT TO RACE, 
ARRANGED ACCORDING TO AGE OF SUBJECTS. 
HORIZONTAL. 
— Age 18 to 20— —Age 20 to 25— —Age 25 to 30— —Age 35 to 40— 


Max. Min. P.-P. Max. Min. P.-P. Max. Min. P.-P. Max. Min. P.-P. 
125 88 37 152 100 52 119 90 29 124 87 37 
120 85 35 110 75 35 130 100 30 ani ate Se 
100 95 25 118 80 38 120 90 30 
135 88 47 133 90 48 112 92 20 


3 eee eee PTO Oh ak eee Wo Sx AGE BB 
SeMIG AR 010 eal seas h Whee bette pe 14d: 5 1101 84 
Average 
190. 989. 36. 1248 90 285. 120. 98 27 
ERECT 


130 go») yao.» *152> 5, 100 52 120 902 -°30-*., 118 100 18 


4 110 ff 32 a nor ae Ary wats 

: 132 100 32 ah ar 50 AGE 52 

: 110 90 20 lee aA 43 155 110 45 
Average 


io Pale WO 128 90.8, 46% o 122, F-92080. 


Six months later we examined five of these runners and found 
the blood pressures lower than at the previous examination; their 
pressures were gradually lowering toward the normal average. 
The readings in these cases are seen in Table 21. 


TABLE 21. PressuRE READINGS IN FIvE Cases Six Montus AFTER RACE. 


HORIZONTAL. 
—-Age 18 to 20 ~——Age 20 to 25—— —Age 2 to 30—— 
Max.) © Min7) 2:=P a Max: Min. +P.-P.) Max. Miners 
120 90 30 122 98 24 110 84 26 
120 86 34 ails mate 3 An = as 
106 84 22 
Average: 
115. 86. 28. 122. 98. 24. 110. 84. 26. 
ERECT. 
110 86 24 130 100 30 110 82 28 
110 85 25 sate “4 a ac os 
112 90 22 
Average: 
110. 87. 23. 130. 100. 30. 110. 82. 28. 


The chart shown in Figure 4 is based on the findings at the 
examinations ten days and six months after the race. The curve 
at the final examination is nearer the normal level. 


ase 
Ea ea 
Baa 
faa 
Lesateaeed 
hams 
a 
ba | 
Ree 
leet 
| wel aay 
ane 
Sea 
pewste =} 
= Es 
GLa 


a0 SAIAIOLAL tik 


Fig. 4.— Average maximum blood pressures (all contestants) obtained ten days 
(line X-X) and six months (line Y-Y) after the race, compared with normal curve 
(ine N-N). 


Each of the four charts 5, 6, 7 and 8 represents the blood-pres- 
sure curve of an individual case. They all show the marked fall 
resulting from the exertion, the height of the blood pressure ten 
days after the race, and the extent to which it had fallen at the 
end of six months. In the case of M e it will be noted that 
at the end of six months his blood pressure did not recede toward 
the normal level as the others; the reason for this is that he had 
kept up his training and long-distance running to the very day 
of the last examination. With the high pressure he still had the 
mitral systolic loud blowing murmur which he presented at all of 
the previous examinations. 


40 


a) 


ces 


In the last case, that of O n, who had a murmur before and 
immediately after the race, it was found ten days later that the 
murmur could be brought out only by his pacing, and at the end 
of six months, even after pacing for a full half minute, it could 
not be heard. In this case, with the disappearance of the hyper- 
trophy which was accompanied by a falling of the blood pressure, 
there was a simultaneous disappearance of the murmur. 


COMPARISON OF BLoop PRESSURE OBSERVATIONS BEFORE, IMME- 
DIATELY AFTER AND TEN Days AND Six MONTHS 
SUBSEQUENT TO THE RACE. 


Piimtiestapies: | to x1 Ihave constructed-Charts 1.to 9. All 
considered, the conclusions from these evidences are that as a 
result of training for the Marathon race a state of increased blood 
pressure is developed, which is considerably above normal. In 
some cases when training is carried to a more severe degree or 
because of a preceding state of the heart, we find still higher 
blood pressures associated with heart murmurs. 

As a result of the race the maximum, minimum and pulse pres- 
sures in all cases are lowered, reaching a point below the normal 


LSAT 


ays | 
a8 3 
Rae 
a es 
Pad Fa 
p— 
Rai BES 
EE way 
athe cae] 


iw 
Ba 
cea 
aS 
ES 
—y 
aes 
yt 
Paani 
aad} 
Ga 


Fig. 5.—Blood pressures, case of H—n; line A-A, maximum horizontal; line B-B, 
maximum erect; line C-C, minimum horizontal; line D-D minimum erect; E, before 
race; F, immediately after; G, ten days, and H, six months subsequent to race. 


average; and in the “heart’’ cases a greater fall is suffered than 
in the others. 

Ten days subsequent to the race we find the blood pressure 
about the same as before the race, or, rather, it is nearer the nor- 
mal line. Six months after the race we find the blood pressure 
lower than it was at the previous examination; i.e., still nearer 
to the normal. 


EFFECT OF CHANGE OF POSTURE ON BLOOD PRESSURE. 


The observations were made first in the horizontal and then in 
the erect posture. The surrounding conditions were as follows: 


41 


Being in June, the external temperature was warm. The con- 
testants were stripped; they had been weighed, measured, hearts 
auscultated, all of which allowed them about ten minutes in the 
room previous to the blood-pressure examination. They then 
walked over to the table and lay down, after which the armlet was 
applied. Within three to five minutes the reading was made. 


=~ 


0) RE A = 

Ba ee 

OS 
om IE CE Re aN 
mez SS a ee ee 
Pe say hE Ee 
eae ol Ll TEC loch) 
Wee C1 OL ee oe oat Parone ey need Goes See Soe Seg 
Le a AS NN GS BN NL A MN ED Wad a acca 

eur koe Fer HE A PS EA 

SS 


Fig. 6.— Blood pressures, case of M—e; maximum and minimum, horizontal and 
erect, and times of examination indicated as before. Mitral systolic murmur heard 
at each examination. 


Without removing the cuff they were directed to get up and stand 
beside the table, not being allowed to lean against: it, while the 
second reading was made. After the race they were laid on the 
table immediately on entering the medical tent (ona run). While 


Fig. 7.— Blood pressures, case of H—s; maximum and minimum, horizontal and 
erect, and times of examination indicated as before. 


I was making the blood-pressure observation another man counted 
the pulse. When this was done, the contestant was directed to 
get up, in many instances having to be assisted; to stand as erect 
as possible without leaning against the table while the second 


42 


reading was being made. The technic of the subsequent exami- 
nations was the same as that of the first. This change from the 
horizontal to the erect posture caused alterations in the blood 
pressure which may be seen in the last columns of Table 5, 14 
and 19. These effects are summarized in Table 22. 


EAT 


TPE aT TT 


SA 


Sass 
ins 
ete 
pee | 
pao bees | 
paren PEM 
ep liees | 
GL. 
Be Ad 
i“ A__I 
V4 OE 
er] 
ee 
Ea 


w Sa ad Ce 


TAT 

TT aL 
See 
a 


PUTA 


Fig. 8.—Blood pressures, case of O—n; maximum and minimum, horizontal and 
erect, indicated as before. Pulmonary systolic murmur heard before, after, and at 
the third examination, but at the time of the fourth examination it had disappeared. 


TABLE 22. EFFECT OF CHANGE OF POSTURE ON BLOOD PRESSURE. 


BEFORE RACE 


Increased. Diminished. Unchanged. 
No. Cases. No. Cases. No. Cases. 
PISS are oeietate te ei cremicn ee oe sree 14 4 6 
Mi aorta Cl Tilneeter akieieis itata susie se 10 11 3 
Miri erettereteconiet: heals ot 6 9 9 
PUTSELDLESSULCG mae cartiecs ie ian 8 14 2 


AA TES Catan terete Site Sie arals sleveiasteiere 19 1 
AVY TA VEL TID am ety. Scere ciataras Brae. thats 5 12 3 
DVUSHTSETAUITE Sit ctes © eth cies ate eteise ore 6 8 4 
Paes t CSSUGE la. meme sites. ois! s 5 12 1 


FUSE Mes iets tee ere acietienle ote 14 2 1 
AUIS aitiealb AWN eA ar Goorttae & aee Nee 8 4 5 
PLU Ey TET TID ete teiavarcielveheistavarsiaretalere 8 3 6 
IMIS erOLESSUNG Ta. oe slelsiereie scree 6 8 3 


CONCLUSIONS IN REGARD TO EFFECT FROM CHANGES OF POSTURE. 


Before Race. 


From these observations we may then say ‘that in individuals 
with sound hearts having a definite degree of hypertrophy, as a 
result of change in posture, from the horizontal to the erect, there 


45 


is a rise in pulse rate, the maximum pressure may be increased or 
diminished, the minimum pressure may be diminished or equal, 
and with this there will be a diminution of pulse pressure. This © 
occurs in more than half of the cases. 


Immediately After Race. 


Following severe muscular exertion, in the greater number of. 
cases, the change from the horizontal to the erect posture caused 
an increase in pulse rate, a falling of maximum and minimum 
pressure, and with this a lowering of pulse pressure. 


Ten Days and Six Months Subsequent to the Race. 
The changes were the same as before the race. 


Effect of Change of Posture in Heart Cases. 


So far as could be seen these cases did not show a more striking 
uniformity in reaction to the change of posture than the other 
cases. 


Relations of Maximum, Minimum and Pulse Pressures to Each 
Other. 

In most of these records it will be seen that the height of the 
minimum pressure was in proportion to the maximum, and that 
the pulse pressure was greatest in those cases showing the highest 
maximum pressures. 


44 


Fig. 9.— Fluoroscopic studies made by Drs. John W. Boyce and George W. Grier. 
Solid line indicates examination before, dotted line, immediately after, and line com- 
posed of dashes, examination a week after the race. A, small heart; contestant 
dropped out at one mile; B, heart right size; contestant finished No. 11; C, large heart, 
left dilatation; D, average case. 


RELATION OF X-RAy FINDINGS TO BLOOD PRESSURE. 


This work was carried out by Dr. John W. Boyce and 
Dr. George Grier with their assistants at the West Penn Hospi- 
tal. They originally classified the cases examined before the race 
as (a) small hearts, (b) hearts of the “right size” and (c) large 
hearts. The average maximum blood pressure of the small heart 
cases was 124 mm., while the average of the hearts of the “right 
size” and large heart series was 188 mm. Of six cases that had 


45 


“small hearts,” none finished the race. Of 17 that had hearts of 
the “right size” and large hearts, 10 finished. This means that 
with the compensatory hypertrophy there comes increased endur- 
ance. After the race, within three quarters of an hour in most 
instances, tracings of heart shadows were again made. The 
degree of dilatation varied. 

The average fall in the cases of maximum pressure as a result 
of the race in those cases presenting a large degree of dilatation, 
was 31 mm., while the average fall of maximum pressures in 
those outlined as showing little change in the heart shadow was 
12 mm. ; 


RENAL SYSTEM. 
Before Race. 


The urine was examined in 24 cases. One showed less than 0.1 
per cent of albumin, which was not of renal origin. There were 
no casts in any. On standing over night, crystals of calcium oxa- 
late were deposited in five specimens. 


Immediately After Race. 


Amount: We succeeded in getting 19 specimens, and in those 
the total quantity excreted during the time of the race, which 
lasted between three hours and fourteen minutes to five hours. 
The largest amount was 220 c.c. and the smallest was 35 c.c. 

Color: varied from normal to dark smoky amber; in several 
it was bloody. 

Reaction: alkaline in those containing considerable blood, and 
in the others it was acid. 

Specific Gravity: varied from 1012 to 1035. There was no 
ratio between the amount and the specific gravity. 

Total Solids: These varied from 2.2 gm. to 13.51 gm. The 
presence of blood makes the estimation valueless. Even on elim- 
inating the cases in which there was considerable blood in the 
urine, I could find no ratio between the solids and the loss of 
body weight during the race, nor to the total amount of urine. 

Albumin: Every specimen showed albumin from mere trace to 
a heavy cloud. 

Sugar: A positive reaction,was not obtained in any case. 

Acetone Bodies: Diacetic Acid: With ferric chlorid a typical 
reaction was obtained in 3 cases; it was distinctly present in 10, 
and in large amounts in 4 cases. It was absent in the case in 
which there was the largest amount of urine passed and present 
in small.amount in the next largest specimen. Acetone: The ace- 
tone reaction was less marked, but present. Beta-oxybutyric acid 
was tested and found in one of the specimens. The nature of 
the diacetic and acetone reactions was verified by H. L. Amos of 


46 


w 


the West Penn Hospital, to whom I am indebted for the exami- 
nation of a number of specimens. 

Microscopic Examination: Every one of the 19 cases showed 
casts ; five of them showed “showers of casts.’”’ All but the largest 
specimen showed red blood cells; three showed large amounts of 
blood. In one specimen I found fat globules. 


At Subsequent Periods. 


Out of the 19 specimens examined at the end of a week, 4 


showed light clouds of albumin and as many had casts. Two 


showed casts without albumin. 
Three weeks after the race, 3 that did not show albumin before 
the race still showed traces of albumin and casts. 


TasBLtE 23. URINARY FINDINGS BEFoRE THE RACE, IMMEDIATELY AFTER 
AND AT SUBSEQUENT PERIODS. 


No. of cases. Albumin. Blood. Casts. Acet. Bodies. 


TBOLORGH are ne sates + « nc eletenve oie 24 1 0 0 0 
fmmediateatyrafterier crac. 19 19 18 19 18 
One week subsequent..... 19 4 0 6 0 
Three weeks subsequent. .. 3 0 3 0 


RELATION OF CIRCULATORY TO RENAL SySTEM (AS ESTIMATED 
BY URINARY FINDINGS. 


Table 24 gives the age, maximum and pulse pressures before 
and after the race in the horizontal position; the amount of urine 
and approximate amounts of albumin and acetone bodies. 


TABLE 24. RELATION BETWEEN CIRCULATORY AND RENAL SYSTEM 
(URINARY FINDINGS). 


Hor. B.-P. Before. Urine Hor. B.-P. After. 
Age. Max. Pee C.Cc; Albumin. | Max: P.-P. Acet. Bodies. 

18 140 me 220 I 160 
36 140 ve 205 I 110 
25 145 re 200 yy 130 " Safe 
27 122 32 195 I 110 25 I 
19 122 ny 195 I 110 ar 
18 122 * 190 III 96 

? 115 A 190 II 88 at ae 

? 120 32 175 I 120 32 1qe 
31 138 15 170 II 92 Bs sats 
36 132 ?2 170 Ill &8 rlow LoL 

? 132 38 170 I 122 34 O 
52 134 34 150 I 118 26 i 
19 118 26 130 y% 114 24 AY 
25 110 20 125 if 110 15 ji 
20 115 es 120 I 98 a Arie 
20 1715 bs 75 Lan 130 
21 135 45 35 III 108 By ate 
23 135 45 ? III 100 20 I 


From this table it may be seen that the subjects having the 
highest maximum pressures before the race excreted the largest 


47 


amounts of urine during the race. The pulse pressures were ob- 
tained in only part of this series, and their relation to the amount 
of urine seems variable. 

Albumin was present in small amounts in the cases in which 
the larger quantities after the race were passed. 

* Albumin was present in largest amounts in those cases which 
showed the greatest fall in the maximum blood pressures; and in 
those which showed the most marked falls in the pulse pressures. 

From these observations on the renal functions, it seems that 
the more serious the disturbance of the general circulatory 
system, the more marked are the evidences of this disturbance in 
the renal circulation, and this is evidenced by the amount of 
blood, degree of albuminuria and cylindruria. 

As to diacetic acid, all considered, it seems that it was found 
in larger amounts in the urine from those who ran most success- 
fully—i.e., those who ran hardest in the shortest time. Undoubt- 
edly, many other factors play a part in this. The amount of ace- 
tone seemed small in proportion to the diacetic acid; one way to 
account for this is perhaps that it was largely eliminated by the 
respiratory effort. 


CONCLUSIONS. 


In the conclusion of this study, it may be said that the most 
marked changes which occur in the contestants who train for and 
compete in this race are as follows: 


Before the Race. 


The average individual who has trained for this race will, about 
the time he is in good training condition, have a pulse that is~ 
moderately slower than normal, with a normal diurnal variation. 
His blood pressure is higher than that of the average individual, 
and with this he has developed a compensatory hypertrophy. If 
in his case it is found that he has a greater than normal diurnal 
pulse variation, that will be associated with a higher than average | 
blood pressure. 

Or we may say that from these observations we are led to be- 
lieve that the individual who has this more than average compen- 
satory hypertrophy and higher blood pressure, will have a greater 
number of heart beats in the twenty-four hours. The average 
heart shadow as seen with the X-ray is larger than normal in 
nearly all cases, and some will show comparatively very large 
hearts. The subjects showing the larger hearts are the ones that 
have the higher blood pressures. 

In the contestant who as a result of hard training, or because of 
some unknown preceding state of his heart, has developed a heart 
murmur, there will be found the very large heart and higher blood 


48 


‘2 a ae + .. 


as + 2 


whe 9 eis RLS 
Sere? cA ey th 


ay * - + ae ys 


SUMMARY OF WRINE TESTS 


SECOND SUBSEQUENT 


BEFORE | IMMEDIATELY AFTER SUBSEQUENT 
i) 
Oo . . 
a a a re Q Pa a oO oO , 9 Pe = Py af u u : ; 
= E 2 5 % S 5) Microscopic a6 8 Seika = Ss g, 5 3 Microscopic aa) = g Se es iS Sn = Microscopic 2 3 oA s Bp Microscopic 
A i | one 4 a 4 & 43 3) alal| o < a 4 A of S| a | a < a} a O | m | a se 
vtec neces LT SES RSE ge Fe ie ee ey |e ieee a en or act os |: Mili Ue Mees 4 ALICE ets Sera oles ate wl Ae Cid SOO 0 0 |6-26 r. 1. ep. spermat. Rn PN PT ee eg ie cp osc es 
SSS © 02 30 tgs) 25 So AS See ioe Singers (a Cees eae a erase Crt ne i ee eS a Se. RN oa ele en Aca wey ees |) Bommel LOR 0 0 |7- 6 neg. Oe Bg ee ov sie the Bibi 0 a's = 0 alantahenet mame eee 
as eae a ere a eee ea ett) eS asctsea sss esaees- |) TO, v. d.a ac, {1030} 7.2 Ill Omura Seto ate ciree LLL quite m. gr. c. & hy. c. few ich ee | Pee on Parte ERE teed ri Aorist adeaa ao rs Bee Pe ree Pe - Soc 
Saree Se Re Ca ee ae ee eee 0 cylind eg rol og ete sake oss oR Sa ck on? Pew eee ee toe e Sel Aabae, [LOGE 0 0 |7- 4 neg. | ooa%e wets einlf « «'fie mse Seachem epee ae ele aaa 
pee eee eee eee 3.25/| a. | ac. 1016 0 0 leuk. es teks an ls eet ope cet es ehaly nine oops aces eo} Deer peeeOlD 0 0 | 9d. 1 narrow gr. c.; uric ac settee oS hoets.<letela Aiea ot Nolaae fe sel nena 
See ak a. 3.36). Re eae ete ek aeaa eaas|) 170 eae alk.|1015} 5.9 II ra ees ieee (dl few otc; fat, globule§¢ |... a) oe. nes cco rsilt eee [eee ol nine sates 2 olf es) eater nee timecnaie arn ey ge doa AN eiasececbes vile sok Se = eee 
- + Se Bae eee 3.36)/ a. | ac. |1018 0 0 leuk. shreds Tiers: deca ac. |1018| 7.1 III O20 o> Slit!" stowers a by @ few oriesinabs¢,  “w» byen cam alka 1014 0) 0 |21d. neg oA ea Eva den ltocuin OPCS wre aie ott ee ele 
SSeS en Paar ere re ef eS ei! yk ersidisle's one's areal) 220 te 3. alk. |1022| 11.27 I 0 enter | ed UI er. c. qu. num. Cap. a wee a Ree Sreeto ns whe ad LIE SAO a ee oe LVL VES a Rta ee eee 
eee ae aes sea ise ee ee Ny Naa sobre d| avec karan ae ee s(t 190 a ac. |1020} 8.85 Ill 0 say Sees rae BS 8| eae gr. & blood c. ti D.fC. Wea Da Calle ‘ fb ies, (ecm ene: oOo ee eals 4 ES eer a ed ne rr ee Se es oe 
PRIS Ss xtc ens re See gecesi kN. Payzec's foc. ages caxeeseee|| 200 toca, alk.|1016| 7.64 I 0 estan ane, ea aA gr., hy., cellular c. t.-b. ©. | We Des. ees Fee ee ae er cre cee te ore eae RN Es I eR 
| ie SPY GI TS EAS EES > a ie bee leuk. Melee ie She occ. “ES ica eae Ue ea PR AND PE SLs Wr Ro ee. 0a eee and nan te ci four Mu AM MM RIT EY Al eegclierncs cu 08 KIA leuk. only Aeckce So cebs Ces oes eee ee 
= Soe ae ers AC. oa. ah aiewe 2. | > 0 0) leuk. ca. ox. tet eee Pee ey | 5A ea Cl es ies Bennet | Ae ee Serge Sc en ee Fee | os Nope ae bara Ue L ) 0 | 9d. leuk. eee Ee ee eee 
See cia Dean ACS | OSS we Fay kes os 0 0 0 42) | nr ae wi lea cate RRS OE eae a eg ea er lea ke eres SE EE cree, 3 a ira Perera een ep re hicy oes a. | ac. [1021 0 0 \24d.).. 00. 0c be ce be ee a win we are ee TS SSS a ea a 
Se eee eee et ee ee laces ove oes eeesl| 200 a. ac. |1029) 18.51) dof I 0 -1see.2..2+.|/$0£ 1] Showers hy., gr., cellular 0 0 See ee te res (tee eee tr rr ye ee retary ||aroxn oo eee ep ep oon vost ch <(4hs eee 
e Bee ties ft» - ace a. | ac. {1022 0 WI Sy Sie ea ee |< Rees aeeeRr | PRG rece ee te eee eg Ne eee Melle Sp en Samu NS a velit, L Pt ac horet uc «of Peace e ere a. | ac, 1020] cloudy 0 | 9d. |no casts; few w. b. c.; t. a.| ac. [1026] f. trace | 0 Juric acid (19 days after race 
1 eee ee OE a TES ee | od eel freee eee | ee a x aa Ag ome Re 5 car ie ae a Da oy a ra pC ee ae rh a SRR TEMA een | Reel Sap TE Noes een eee Nee Ree Re Ie oe ee arts ni cd pease tc wo ce Dale's ote sy one 
Se are Seg OSE, Ee RRA elie aaa ar (ie ica-ox. standing): d. a, Alka LO20| sees." III Oe teleemercatents’. se ] broad & n. hy. ec. © bec: swabs €.|| a, | ac. )l000 0 0 | 9d. one hy. c POM Pe rs Peri ce 
| 2 ae ee ces RSET ORS Rare fe ee a 9A) SS 05 ales Ree ee eee BD d.a, ac. |1027) 2.2 TT Poe parton tee wea. a Lileyehowers muh yer cots. DlOOdiiny... -crnmr 4.". ers er eS (ee ae Bec i alec cele cccaee dela selecche tesco aleacu Saves ef) Daves [tetera [Ss traHle qtuco temteted a kite ttt sista i 
. le ee OPC samaCn sens Sos ss «|. O 0 ca. Ox 195|smoky v.d.a| alk.|1024| 12.26 I 0 eee he  inone*seen > lateeramt. blood: ae ween 1D: dae L006 0 O |LOG.) .. 2. ec ca cabs s cele e wea che cele e|[ee sc Peccee [ae © elle cree otal) cpeme a eine eles eletae ita 
) ee seat re a oie Al... ocelot. sae. eveees|| 120 daca: ac. {1085} 9.78 I 0 red ring II showers, hyere tailedycm | TUNG: mews D-cC.||Ei: ere ees cea cea evra aacahiigy elite ec c'e eu acids cle [ects [pecs oilletetelni satel eapelet th irateieti te iti os 
SSS = See rapes ac. |1024less than ;,%| 0 | part ox cylind. Ree hE os a este iis ei | Sa ee a ete ee eer oa Deen | een meetin cn eccilis mah AC. OO) dace u Oy Nese Onan cylind.; ca. ox. AUN ae eee wee eta oy eee eee 
Se ee eae eerie ae Ne ee ee ee is ans |c a ealemsclac vee sie cee see eee cece cslecnccaacese cid cece seme este eee eS aa seeedenee ee eleaee ce sete ane ess HAS AER a tee have eee cecleeeelececceec ue dateeh sels swe cere cue e ull fcr ofl araueeceecills cms eteisil lh ® lt tattle eet 
tose eee EAC) An Pic ig ae es ee cc] se 0 =O ne ERR eh Se Sees (etic re ORI Khon etc |r Moe |e ak He oie Ine et ae ORs on hd once ales ma etveaehr ont atall Gy eeu) Lee 0) 0 | 8d. few cylind. Rs Ps Ws 
“eee 2 St ee ont DES) rye Al BG Beier ee See ean Presi lieecrogis deans aeot tend aan eee De soitea ele pai oh Seen Re a ge 5 oe ge AS a Mia eg Lee Rc Re Gn I: PRN Seater ie ci ace ac lovcsacccculeccelescalecaescideteceeecke cass sceeeeee calls ane efe ace} s7eia nt) Cesietgtene =] te re titestettst 
Eg 8 GO ed oe raed (eS (eee SO a ae ee ae een re Pee ole Wey era. 2s ela ipa Ie mremeuee s aye ee apolar ie rae all>. © ears cesqeratatetel hts SL saree he reek earl Sere A aula cccelees evel nue serch pcuelee cele ested ules s ¢fecctecoi| duet siel ie: saiea aise lfeseeiets (Met siete 
Peet eo i OO) a. | ae. |....5.:....2.-2- 0 shreds leuk. 130 a. AC TOO oie.) CAtoress et Osean ed eyed aps IV none found féw r. b. c. a. | alk.|1021 0 Ub COs (en ee 7, Me nn ee | Many ey rR RE eae hel Geko cc 
ee eC er ee Nac, so |. <falel eis s | a's cs bis wes ee se 8 190 d.a ac. |1026)1 .5 1 Lie oe () oxy butyric I narrow hy. rb. c. ow. Be Clo. clecccleccghececscveccl fc aclle ves fletsle'sctel’s cr aneticbes schol. @ ccs ccccstsrcc [lcs ccc pele tena /ial at arta tata iat] iene tic 
a SSE) Ee ers en eae eee | | 2 ere ey een pee pean en ee ee oer wrens. Wok aeraRin geen  guteMintae ta... A). ar earcneae lente aNenetestelat arene at «58 ell acl ee oT ee woclecsclewscescceecsdoparcecleeccvewet: [lec culled ete [a ote tate etelete! | nee Qi a= ies 
18 |38.04|| a. | ac. 1022 Oe crap ee, i oat 125 d.a ac. |1024) 6.9 I Ce eee een aie; I hy., gr. cyl. few w. b. c a. | ac. |1016 0 OE AC Ue ba pes Se ee ree | Pe ere Per At ery occ es oe soc A 
17 PS ee ia eee a Beige coe eet Sires! ofarne Ses af;.01 bas AO aE a a IS oC oe Al an iP am OA SS SNAG rs Ce a ge a Maia ete eee cecleccaleccccceuccecuaheeeue cama eetec alls cntulle catalan cts omitiete alates at@NGhs | aie: sea 
15 48. | SE A Ae ea 0 EOS | need DOR As peda Fae 150 aa ac. (1024) 8.3 | v. lxel a Weer ar eae I many n. & broad hy. c. |r. &w.b.c. ca.ox.|| a. | ac. |1022 0 0 |10d hy. c. & cellular a. | ac. |1020) f. trace hye 
oc cececlecscleven[uceeee[cceccncc{eccuceee[cccceenccccc[eceecs[eceucceesecteetecencanecnetsfesstaeesccseressl[ecsslecsafoesa[ecececees]eree|onta[ sens edhe en 40 Obi Galella Mtettsre|) cele) tats) =ss 3-0 |= eit 
EES Ss Te ry a aa ae eee | ners ee Ce Ne div nc gceccctile ces calececccee glee vsvacuenbevscageped cece dee cee cre eM[ee be [ae eefersesersegre oi ete [euapene| alata’ ills i a:mesRlels tee lalla tetas ete 0s es et 
15 EE iS EY i a nS er a a. ea O20 eee = 1 eae tsa ee We II showers hy., gr. & blood c. some t. boc. re 
12 ee ee Os he ee i le ss |e ee al nate wie ofc oe we ofereleie «ale ae cod eimece tele lee ole cee aieinlele eo oa +o sfalitle oye stele « 015) efsilia sea efeeie eae nye aves RACs ios as eae ages ee es errr s Serer errr mrmrres (etre i Cres gers nui een cma 
fg ae: 10, CORES ec Sh 0 0 ee I Se PA EN 9 RE oo a caBei hic og one ele | ci kcerare’ « exoreouchel|lans wince) il'a.o oc€i ene artis ws puaeeigis wisimiora lone y ele'a'erae s syeie s.clieiale » sale d.a.| ac. {1025} 1. cloudy | 0 |10d. neg.:; exams. |i... .|..<choacclcacnccomlece se osm eae 
11 = |2.00)} La. | ae. |1028 0 Sepa a erates ea cree licscisislls elas ie c+ = 20 once alas | nla nia wie wasn ire] age oz ein arlene > Seen einiane meee oilman Sensi alah SP se slhctat tial ae eee tena eee a ar reer GN oe ey nt iy abl cl ilies [eee 
11 POM et Paw. ns ae os os SS 0) CasOx | caer a ep ee I Deena aM ce el ney ee ems Some ae EN evn ams aR Cec hot ce a MRMera® «ps oop gate apraearal tay one Gua logtte eps Gta .a.| alk.|1014 0 0 10d 1 mucous cast a. |ac. 11010|- 0. 1-0 lo “dchwe meatier 
TeMeni oe che PAC Wl oe ee eee} 0 Cees ssid axe Scans 170 a alk.|1012) 4.75 I UNM Ee Bee ears oa 0 many blood.& gran. ¢.— \r..b..c.. “Sw. b: ¢ e wag Tied oo 07d [erates cafe’ gtr eo Dios ed Reem gene eee ee ee a Plea : aa 
le OS Rie sas URS 6 ones Or a SoG hee areas er et a ee ET cn Re BE Se hgh AEH ee Ae Pa OS er eee ee end eee a eRe Sh Oke Tih earl Pain amet he eo saline Diedesac © een eee wwalecesdeceeseucuce aah acgleccvnce vous tiles colette Rey ys: 20st 
CO ATR eas ee Re 0 0 i) 09 | pean ree alk.|1021) 8.56 il OZFe Laer esa ee II qu. num. gr. & hy. rb.c. w.b.c||p.a.| ac. 1010 () Mahe et. Re cee = Mee 
A | ser ete Pei Perr Pee INSU SUORORD! [ene [een ODIO nt cbcenen (NOODOESORISE a aca ee ne 
SG | BO ere Re ne ee (eee eee eee Bene Corea at pas 4 ake Ma hea ce Niemen NEN eh ede eye resis s/o ces ene 
16 | So Pa Seek Seema Oe peeves cee ecesed [aoe s[eves[eans lees cigpeeliote sewed eles suntan gale eas econ 
CS aes Ge a. | ac. |1020 trace 0) i) MT Atel Oa coer Ree oe cer ilar cee ss SZ Ae) SIG Shea Stell ote a: Sole l/s a, w alayeestarciah w WfbMiw 2 aie ¥e eho, wha, Ruell loud o-e.9e; 6 wa girevahe ace 7s See ee ore Ws wnietete OSG ea. Soe een aes ; ree 
12 rae a4 ace |10 0 0) 0 Ae Se eae Nees tee ena Eo ava re arc ails Sere Fan |famsten bee guess cai). “caw cbactatu one: Gyare lelars | Sade Ney acu apaieve ta yeial sara ee MOA Re psig Src. ORL Ea og ere eee ee: ie er 
eee ae eee ee ee. |= 0 0 0 Re olan Oe mec alee ch este Blea 2d a a ae SUN DORE aie ane Faber Acree ie perl Lear ven Pt aan cased. exe ena eR ee Rene 
MEMS etayaeistacs'> «2 MAE N tie eerie ss 2 | U 0: 0 | Cea EICE RENE | eae pe a 2 = iam (eins acc Re a Ran eee area AEE’ 7) OMMMPMREE Ate nasil ice gral lr geirh. coca wer reer Rickk ceases Gita, 00 0G pete eke ad a eee | on Sa Ee = 5 ee 
13 RN ee ga esc Pamela TL Se a Pe cae See re Oe eA eee ote lleses 2s Dros[ecccevaevess[ecsees[sececeeeetduastiersetesecccelscsesecetesvereslfactalecwslerseleesctaaecc/es clea tee oe lye te amitenctGiasgietnss ait inset ec. 
24 a. | ac. |1021 0 Te 4 On erate Bl. ks eee ac, |1026|...... I Neat ee Ree 0 few n, hy. c. oie he ah ree Seavseeueceuaubueacucesueun swell cs selee eatin: ales alike glasses 
2 eee pee Ae eee | ee oe IIIS 
I a Sa arm Vira ni FO rns nena Penn PIO DORE ES res MEI ESSERE rasa: Ereerareearacen linen irre tere Perens) rns te Sls 
ns =| (7 cell Sebrlsphneit Fennens Revere REE )SDTEN IssStesebecoreabepesbs see DOD SSO SsEESTEs ee Snenmneenl benbebeenneial EI ff 


pressure. Body overweight, laborious occupation, short and 
severe training are productive of higher than average blood pres- 
sures and associated hypertrophy. 


After the Race. 


As a result of this inordinate exertion, if he is of the average 
class, he will have a fall of about 20 per cent in his blood pres- 
sure; if he is of the “heart-murmur cases,” he will have a still 
greater fall in his blood pressure. If his heart shadow with the 
X-ray shows a marked increase in size (much dilatation), his 
blood pressure will have a greater fall than if his heart shadow 
remains about the same size(slight dilatation). 

At the end of six months the blood pressure is still nearer the 
normal level than at the previous examination. 

Most of these contestants had been running during the preced- 
ing six or nine months, and it is natural to expect a gradual dis- 
appearance of the established hypertrophy, as our findings bear 
out. 

The change of posture from the horizontal to the erect is fol- 
lowed by certain accommodative changes in the blood pressures, 
these depending largely on the reserve energy of the circulatory 
system, and the promptness with which it reacts to the force of 
gravity. 

The effect of this severe bodily exertion on the kidneys is defi- 
nitely proportionate to the degree of general circulatory disturb- 
ance, of which the renal circulation is part. 

In these studies we have had the rare opportunity of observing 
the transition stage from health to disease. Beginning as physio- 
logic changes many of these cases have transgressed the dividing 
zone entering into that of the pathological. The exciting factors 
once removed, a recession into the normal followed, in some 
cases reaching the physiological quickly, others slowly, while 
some, it may be, will never return to normal. 


BIBLIOGRAPHY; SELECTED FROM HIRSCHFELDER’S DISEASES OF THE HEART 
AND Aorta. 1910, 


McCurdy, J. H. Effect of Maximal Muscular Effort on Blood Pressure, 
Am. J. Physiol., Bost., 1901, v., 95. 

Masing, E. Ueber das Verhalten des Blutdrucks des jungen und des 
bejahrten Menschen bei Muskelarbeit. Deutsch, Arch. f. klin. Med. 
Leipz., 1901, Ixxiv., 253. 

Gordon, G. A. Observations on the Effect of Prolonged and Severe 
Exertion on the Blood Pressure in Healthy Athletes. Edinb. M. J., 
BOW eC II: Gel, On: Dds 

Tangl, py and Zuntz, N. Ueber die Einwirkung der Muskelarbeit auf 
den Blutdruck. Arch. f. d. ges. Physiol. Bonn., 1898, Ixx., 544. 

Kaufmann, M. Rechgrches experimentales sur la circulation dans les 
eae en activité physiologique, Arch. de Physiol. Par., 1892, 5 ser., 
iv 


49 


Bowen, W. P. The Pulse Rate as Modified by Muscular Work. Contrib., 
Sc. Med., dedicated to V. C. Vaughan, Ann Arbor, 1904. 

Hough, Th. On the Physiological Effects of Moderate Muscular Actyite 
and of Strain. Science, Lancaster, 1909, N. S., xxix., . 

Blake, J. B., and Larrabee, R. tas; Scannell, D. tbe Tileston, W., Emerson, 
W.R. P., Strong, L. W., and Conolly, J. M. Observations upon Long- 
Distance Runners. Bost. M and S. J., 1903, cxlviii., 195. 

Dietlen, H., and Moritz, F. Ueber das Verhalten des Herzens nach lang- 


dauernden und anstrengenden Radfahren. Mtinchen. med. Wehnschr, 


1908, lv., 489. 

Bruck, E. Ueber den Blutdruck bei plotzlichen starken Anstrengungen 
und beim Valsalva’schen Versuch nebst Bemerkungen tiber die 
hierbei eintretenden V ea ue der Herzgrosse. Deutsch, Arch. 
f. klin. Med., Leipz., 1907, xc., : 

Williams and Arnold. Effect of iclent and Prolonged Muscular Exer- 
cise on the Heart. Philadelphia Med. Jour., 1809, il eaes 

Potter, N. B., and Harrington, J. T. Medical Supervision of Athletics 
ee Boys at Boarding Schools. Jour. Am. Med. Assn., 1909, l1ii., 
1957. 


rw 
[a7 


THE LIBRARY 
OF THE 
UNIVERSITY OF ILLINOIS 


GENERAL SUMMARY 


b on : pee Wt. , Training | Day Prev. Blood Pressure Baore During Race After Race Subsequent Examinations é LAST EXAMINATION X RAY : 
Occupation | Work Hours Habits es |. S Lost PANO Heart Pulse Weight Gained 1 On 1 - 
’ 4 sm | 3 |Z uns Pulse | Temp. Horizontal Erect | Eatand| Eat and : Loss i : 4 5 izontal Erect poo woe, ; 
; 7 4 7 Zs | 3 = Lbs.| Marathons |Dist. aM. p.M.| MO. REC. 3S . oP s. oe P. Drink penis Cramps Het hao. ee! Weight gue nee ey See ass OS Pie fe Home myect bee toe sf D. PP.|| Se Betote Goes = AMO: ee ie ; 
Poy Good Byrs.| 2 0 o | 4 3 he- se . 25,992 1008) Negative | 77 .. |105 .. ..|.... .....| Light 0 0 0 | 99% 1022] 3% |114 133] 182 112 20 | 105 90 15 |Sitting 84 115 85 30]... ... .. ]2 Ibs.im Tday ]].......... gee Re eel (a es 0 cI ot RET eS Uieer cac| kv See th a tht NSS SSI z i 
~ 9) Good |l0yrs.| 4] 0 | 0 | 8 1 oT SM SSR oO sere re o160. 4. 120 Re) oc. oe. Light 0 | Stomach” | ,Weak and | 973 1002] 4% |100 120) 115... .. SS oy |5B* 66 1128 95'., -|| 188 100 88/4 IbsJaMelS daySadlt oPrcccselt te cos csc lle «ae gael | ier ee xc ce te | cau ane ee MN ce Pac Sate er 1 wk. later showed most extreme dilat. of any 
104" Good Tyr. |}2 | 0 | 0 | 0 fimar.s15-mile|.. .- .. | 99$ 1003 0 2) LL) eee sree |B. Light 0 th Mi | Syst. Base | 974 1004) 43 |108 ...| 180... .. Hes MG Sel Tod ee eten Ea este See MI) rr | reel Meee eters NER ennai | Raed ieinn cor’ Sraatisd or,ca2 ly doccacoaddaonen hooks MM oonadnoneass 
Tae hese Good lyr. | 2 3 OF} 12 3 12 72 68] 993 ....| S. Apex | 72 72 |110 90 20/115 80 35] Meat Both For 8 Mi, | Syst. Apex| 992 1012} 4% | 98 112] 95 88 7] 98 90 8] 50 52 [125 88 37] 130 95 35 |311bs.in Qdays || 66 74 |120 86 34 /110 85 25 ||110 right 95 dilat. 1 wk., recov. to less than Ist shadow. 
Night 5) Alcohol lyr. | 1 0 0 | ? 2 ie “cia t SELE ane 105 97 |182 98 34/128 95 33] Light 0 Syst. Apex|.... 104] 4 [120 138] 95 8015] 90 ?.. | 76 80 119 90 29] 120 90 30 [2)1bs.in 9days |/ 72 82 |110 84 26 |110 82 28 left dilat. 1 wk. later, outline narrower, slightly to its original size. 
D. and N 8 y Pp t y 
Laborer [aiternate 9 Good lyr. | 0 0 0 | 15 1 DAC MO MED SommLOUA I Ne xativey sil W. eiOS) Mame: ontseen ale||-v sang sto|sisvicicne «e/eiee corns emcees Haremie mere NCEE HF VE MY Carl) MEA ccense || Bab eano collec Sel bron oerd |peopnoeranel Raseeacc. o00e000|||baoscasedn opsetcccsocra ocorssermedc ||enounc lossenonoocosotoopd Von Gn\lan sobdsoneccotoctcach SaocongQoooo whee 
Puddler |N. &D. 10 |Tooynucn Mest! 1yr. | 3 mie 0-| ¢ 1 3 55 65)... 994] S. Apex | 63 76 /132 100 32/182 100 32| Light | V- Light} (Sig. 0 ie se] GP oeP MS) To, NCE) than INGE PIN I eI | GIR TOE ooh... coosacacelllppnooedoonlleaeo°dcoed|snpeesanccns much larger 
Waborern ici tno! - Wegtarien [2 ¥t-|0 | fey 08) 6 1 - 1002 1012 0 Biers 140) eee ieee cel Light sp Onene 0 0 g7§ 1008] 17 | 84 .../ 100... .. see Deter || chee Mets | Ee aceers cin teehee |aanenecthebrteteewel oe ak oe allie ocx gan padlloee Seater lh pease eaten ale er ne cs cleo Sea a 
Wend JS ek Se ean Meatt id. |ayr | 3 |Cigars) 0 |... J1mar. vothers|--  -- -- | 99? 100! 0 GE ny /108! rer al deer ..|V. Light|s Raw Bees 0 O) (OG LORI AR |. OO a) eee Pe Gag hies coe ac] aah wat les |b conew pigeamea ancl eee Nemes Sauie es ser lack Se uae aw a]| abet acts avec tear eee eee a 
Bae reese eae eco Good Pye. | t ae o~ |. 8 4 3 70 78 | 98? 100 0 C6 Simeae 1 (40) Meera) Rece Seelll: waen oe to e Soh ae el 0 ee AGL] EM TG ee ill cea ao ee Ill oe Red rR ee ae me ne Se yt ell Oe all aoe cbt manan ipaoeasacead PS eee een SE ee Se tt ats ; 
1 ae Se 14 Good lyr. 0 ee) 3 ee |e. 1002 0 78 90 /120 85 35120 80 40) Light | V. Light Leg 0 100) 1004) 0% 172 112) 100) 70180 |) 108) 75889162) 80) /120) 85 401/130)100) 80/8) Ibs, amid Ol days ying, oss) eeiecrtie sls sseeeee excessive dilat. 1 wk., recov. ; pul., art, & left auricle smaller than Ist ex. 
- - Murmur After Pacing 
. 34) Coachman TI) SR 0 0 | 8} 5 .. .. .. | 99% ....) S. Pulm. | 76 80 [145 100 45/140 105 35/F. Light 0 0 0 97 991] 6 {100 108] 108 80 28] 106 8020] 68 74 |152 100 52| 152 100 52 |6}1bs. in 10 days || 72 78 |122 98 24 |122 90 32 left sided dilat. in 1 wk,, original size 
..| Merchant 8 Good lyr. | 1 0 Ocje8 3 pee 608 65°/1008 G2. 0 74 76 |125 100 25122 100 22) Light | Water | Abdomen 0 98 993] 8 | 96 100] 94 7420] 92 8012/63 66 |110 75 35| 110 80 30 piace SIR ee lee A vate scallelehtacceseee|U45.° 9)” “erighit RSet a ae ee a 
.. 83) Laborer ee DCR ese | alseu ie Only OP 5.4 3 eee |100 6 1012 0 80 .. 145 .. ..|... .. ..| Heavy | Heavy 0 0 99" 1021) 28 }100 ...) 180... .. Seetpiobers Al eee err ere RP A cineca | eo Ee ened Ronn cnpanaee |Meadne lds condctnddnadcoco|(> ical Scaanaaosaeehoagveraaconusdccosn ak o% 
Hite see ee Clerk : 8 Good Lyr. | 2 0 (9s 2 Here || 9925... 0 84 84 110 90 20118 85 33/\V. Light 0 0 0 1003 1013] 4% |104 120] 105 80 25] 110 75 35] 52 70/120 95 25] 122 92 80 /44 Ibs. in 10 days ||..........|.--...---ses/eee-cseeesee dilat. both sides 
64...| Teamster 104 Good dlyrs.| 1 3 0 | 12 3 eee ee 00% 100% 0 (So ea BH Gs 5 gal iat oor an) fAYAglbpteatant 1) 0 0 972 983] 4 BS NLL oe at peerage coenie allies Poe (eeeeniear meen mn conerias (Per! 8 crs) | I ee ta nent] Moree aston eter latarrineseiconms Sse: ccd Awe cceerhenormnery: Coca ron l 8 scone 
74...|Light Labor} - 8 Good lyr. | 2 0 O |....|1moainedmar |. 2. 1. |... 1008 0 106 106 |185 90 45185 100 35/V. Light] V. Light lonce, Rt. Side| 0 981° 100a|44 108) 116) 400, 80020) 88. 7bi18)| "89" 190) 118 = 80) 38) 120" 8080) 11a Ibs sane Oidays | eee auleeonecer eee saneneeee dilated 
5%...| Electrician 10 Good Tyr. | 1 0 |Ale1} 10 0 5 60 74 |100 1004 0 Cla wag WUBIN Aline one rll WEA Noaisteaate 0 | 0 GOL OUST SOO Deh LOB eee ech |i aefencctsicn eerie A |aeeooe goal eae soll aja ate ehepersteta/ebrietnr=t ll ud ufayatayey seyel|(sravetsiei=?e1e¥=\ eta | {et rey eiaye oy xtctarara||lo's/efonnyal velotVale tayo leioxaliatete}efo|| eta fopfoll orate tenet sfetstayete et state ts alate late atest eaten 
81...) Bank Clerk 83 Good 9 yrs. a 2 0-8 0 wae Ba Rat MN aga 0 66 76 122 90 82/118 90 28) Light 0 0 0 CH ai) fet Ce Tore) ia lelin Esai ZEy GRAB SU eI iby Ce tien TIGERS |/G4 98 5c! beanonoccon|lossnnoddeosa |jeisacd ydcaronsnadsqsones fossas 
RS Te te is ermal Ce ara |edit (C(O UU, (CR Sg (|e td ind i a eee dah | een |lemem ne come Go |g [oii SoS eee 
... 8 | Teamster 10 Good lyr. | 2 7a 0} 8 Bi5-mile|.. .. .. [100 1004 0 94 .. |115 «.. ..|... .. ..| Heavy 0 0 0 982. GOI ea] 94 ATO)! OB ccc cag srer gies we cdlhan 9 Gel liane Melt dine: caress Me-csoa dele emer eectsrege cs levee ae betel Svcvarscese-one acres Paveve eyavcs desetote| | ers vee etetersteretettte Slee eaten nes ae | an 
CE Soll ae eee 12 Good lyr. = 0 0 3 1 pe ee ere me) 994 0 OG) (150 Gea cee eee 0 V. Light 0 0 99 102] 2 OB Perr | BO epee wal | rauesteente oe le te wid) leigh soa] ies wields we. |la's boule. GeQletatateetsiote eM lP cae a heleceualte'y abeels overs ie aval|(Goendsa’e“evesetetate;cilfia%e ares slfts., otctala o(ufapcsxtetavmtONets tall leh=T tae | Stat ae cane ne cee 
Dae: Pelee. 12 Good lyr. | 1 0 0 | 38 1 eee race 101 0 80 83 |130 100 30182 110 22] Light | V. Light 0 0 100 1004] 12 | 90 96/100 8218] 85 7015/72 90 |188 90 48] 128 9838 |721bs.in Odays ||.........|......-.--..|..---200eee- 130 |right (dilat. to lefty) 100 more dilat. to left 
.. 64 H. Laborer 8 Not Good lyr. | 3 0 0 | 10 | Short Dist. |.. .. .. | 983 992 0 O2re. [L807 Meee te ei|| Lamht 0 | Right Ribs 0 Ste SOB eee || OO) 0.) dO moe, wal tetera ae || cee a) | Spar nn | Pease | PPE M0 | (nen pm een een en ee etna | Penne eR SAN! 6 lA 14-9200 sano an Soasecobore hase sos mag ee 
... 52| H. Laborer 8 Good Qyrs. | 2 0 (i all Eee 4 Sart ye hones ae 0 67 72 |120 95 25/180 100 30)V. Light 0 0 0 985 994] 2 SO) (Bi 110) 27288" OS SONS 85 se 76) 120" OO 80120) 290. S00 | Sits amine ial yi) a leer] ere re erennrearion leer paneer 120(a) right + 110 no change; diaph. higher 
EOE a Cc eee 5 Good 20yrs.| 1 4 0 6 8 iceetreln Ad PR aba See 0 CP i |G cline Se colNGabir gat: 0 0 0 OO eeLOOP ema a OG. adel a) cit, aeerpereied| | meen eter aeons alms sta [is ete eels cali cer Fel termie vo. eve eco :a 0/4 olptatapurenete lateral ucrzje/eroreserarall etajaletere sim.e a = el|farnuctecelcte.etttetes lll five: ofevalfietosrks ato steteratatalet tie tetel fa ciate fad ie abel tetae = ee sate ake a eae 
124. M. Labor 5 Good tye. | 1 0 0 5 1 8 54 64/99 101 0 92) ee) 120) eee serene = (Velen oht!| Ve ilipiht 0 0 9SF= s1OQM eS ate TAO) Seis) £O0Si% ci ent ice eevee eee Sie cceee ep ats oral -aterae avatar, moat lle aserssayeselaeetayoletaretetee ll apere peceis eaves lleversie cinem cam ltarsi(tecaser syopetaccrat eco elf arzarelats || exeiay atelier tet rete eeene re | REP tet es okis ate teeta eee Te - 
54/V. L. Labor 103 Good lyr. | 2 0 0 4 3 Pe DS b8 |... 99 0 54 74/118 92 26/112 92 20) Heavy 0 Abdomen 0 972 1009/41 80 116) 114 90 24] 108 9018] 66 54 /185 88 106 84 22/112 90 22 |/118 right 114, dilat. + w. 1 wk., outline less than Ist; diaph. rev. 
serio (Ci = Se aoa Good lyr. | 0 OU a. 0' a) 42, 1 = //982 1008 0 oe LO Me a 2 Sco eS OA Ae = tae 0 09). 03H heme | 045 0 73] = GS iene my leew ereerse ||| Laren ||le eter sessions) abivste gull ava bdchois arecaleal | oteronsee all eaves gate) Sk eee eae eee eee eee se eae 
Bis Clerk 64 Good 2yrs.| 1 0 0 2 5 65 70} 99 1002 0 72 ,. 120 .. ..)... .. ..| Light IMuch Water 0 Irreouilam, "952" O08 Se 62). LO We 2. |) vente ete il cu way We wteo aimee wal) 2 e0) cece, ST [eveve mie a ocauaematacterelewel [Mos chs ote cyetrslherwievesecenw’s suave fletchatararaueiaie aun alfficrcte eles Rcapco te ei ehal ce oven ney et eats 
30 11 ...| H. Laborer | D. & N. 10} Good Tyr. | 0 0 Gas 2 eee 100 0 65 70 1110 90 20/112 98 14)V. Light 0 0 | 0 953 1002) 4 | 81 96 110 95 15 | 110 9218/56 658 |112 92 20] 118 92 20 [8$lbs,in Qdays |]... . 1.1.) |... eee ccc eeclecsceeeesee. 110 small 110, bigger 1 wk. later, outline bigger 
31 14 ...| H. Laborer TOM eos Oh tyr. | 8 Ope 0 |, “7 2 .. .. | 992 1004 0 64 (i115) See, 22: -|| Heavy |Onenee ancl + 0 OStpe Ree POG: ee lic $n ri fea ntalenme vel! canted ye ea len Se oe) QROEMPaee oar lah eather Pose ie r/erescice mie oerart amet Seen fe eee eee en | ee ike ecu serenity eee eS ames Sere 
: e sacar te Pat cal ye : : ; ; 36 [128 98 ¢ 3) 92/5 s. in 20 days | a : 
32 PG \ Meahanic oe Good tyr. | 1 0 0 7 2 3 56 68/994 .... 0 82 78 134 100 34/138 100 38) Light 0 0 0 981 1003] 18 |106 129] 118 92 26 | 108 90 18 - a ee ae Pa nn Ai a re in " ae Bae Sead Sones GERI |e beiea ies a 134 good size 118 excessive dilat. 1 hr. later 1 wk. later, not restored to former size 
33 13 ...| M. Laborer 10 Good lyr. | 1 0 Oe eb 0 , Gece 0 80 tre | Seaham noms! Teht yecawte << 4s 0 pee eel OD 190 Rielle wn ell Ween eNO 6 Rule Otoko ell 4 Meese: 7 aie t || eeine | Ce eee pen nnn Re res or Yn os Nader onlcwaoaunddeeardne 
34 ... 2.|M. Laborer 9 Good 1yr. | 2 0 (yey laa, 5 5 652 58|.... 1002 0 60) | 140 Mechs Sal eau 0 0 0 TIT pees | apr: NRG ieee ee et land Ieee mira eieat|| RAN oN ee 4 mi sicsas ni: vein fase as5-:stoPeibeiatanrsctobetcei lo cca caee cece [ ostaccvasnschcctacl out ovchawel Cases Peek nrc legs Sch esele ets Bc Nee en Sa 
35 34...| Clerk 9 Good lyr. | 1 Se yend.) 84 1 3 60 621992 1002 0 Hie, (120) Geel Peewee, ell Tietit 0 |si-PaininSiae 0 Gh apeclh cel Mee on cortse |onowats conn 9 coe Hand ae wal cas. wgn se Pesan oe Meiethuarounisel[lceascc ccc [nites uc ye |oigcicesats hace omeecd| iad a ROMs ele metepnens| eeelien Lessee een ee ne 
36 | 25 | 6- 168 | 64...| H. Laborer 9 pepeeaD lyr.| 0 0 0 8 0 13 50 70 | 992 100 i) ie A Ge os Gulloaas vec = 0 0 i) 0 97 OSS pour | 80h cac lense nme ee (Ut tet aero t al [or sa (|ereiet cejee fecell) einje. Giggs sped {|iniw aie cr ow dateolaveletesavere:allllavcrsis oteGcetera||/evsva sao alaresece s]{lerecy a ouaiersye ce sc] [lalave cheval ova vistere re ecatats tetera fe [eo gene fae Male eit Sant ta tlle Ee 
37 | 18 | 5-6 | 140]... 6 Laborer 104 Good Lyre) 1 0 0 10 3 oe 974 100 0 68s 120) aarti ore | ight 0 0) 0 97 ten’ coe OGr yer aaa sieeere Go more’ 40 we loge odie wall ere: eels (a |'o 10 cue vielayefecololnie tee /slll © yasare-oi aie a \|lsietevers «sits erevel]ls e(eie mv vee.) 500\||ince'e,«-s ll a/eranara:Bietalales poate 6) sim tetei| (eo lahatental (alae inet iad etls Settee le fe alleen eee Lee 
7 Sy oa ea be ie ae eee 8 Fair 1yr.|2 | 10 |Beere| 8 2 is 1O02N Se. 0) 69 76 |124 95 29/120 100 20} Light |..........]..........0- 0 98: 992] 64 | 81° 99] 80 75 5| 95 8015 | 56 521110 88 22] 110 78 82 |bRlbs.in Odays ||... ||............1.......0..., 124 | tight BOI. 5. sec Aan ee eae eee 
ce TON) TEN Se I, Be Re ee Fair ty) S| Weer. < 2 S (in GO) Vso Apex Basell| 87 84°55 180) 25/140 118 24), ok Note eecsac[ecenencee: 1 OO RoSenOMl 1108) 120i) 02) 79/1490 82 eae TON meee. A PS are Oi os occinnal sec ia deals tee eral ae Eo 155 small 92 dilat. more than ! former size (11 miles) 1 wk., smaller 
40 | 23° 5-5 |130)... 5 | H. Laborer 12 | Only Fair Ayres} Br -|. females a 5 3 So deepal RPS ao 0 66 66 |138 110 23/135 100 35/V. Light 0 0 0 993 1018) 13, /114 135] 108 88 20} 108 8820] 66 62 |125 100 25] 182 100 82 /2} Ibs. in Odays ||...) 1 1|............|......... 0. 133 (a) right + 108 no change ‘ 
Si 2 SS al a ae he es ae lati Ame he REE Ses es-998 0 BLO Ae (SOMOS REE IG OMIDU MAILE CNA ene alle Bees Cull, aie Sanehe, | 95+ 9721 4 | 60 81] 122 8834] 18010030]... .. |... ite A. SOR Beds ast Can ierek aaa ytae lly Nice ae 130 pay 122 
: 42 |. Pe Se yh | PT a eg er |e cl. Seeman les voc pec ee clee 994 101 0 £000 ee t4b een te eee Ca Weioht 0 (0 0 Oi ooh a 63, Sele See ee ee re . Be a a ie is zo SE eats sae eas Pence ake Panay aaa ie g 5 Gee "Fe AAAS aaa pepe 
2 Seale : cle. a: ery ie eae Eeversevevallecseceetaslunsesacsuese|indeceeceed- [fic conalish ass oes ausd sues) ah Aiile] sane? scsi iees= iaeen an tea mana 
43 Sie 1 1 mies (LOO! erect. 0 15 76 |120 88 32/100 80 20) Light 0 0 9 99° 98. ter BD INO) TAO BB Sail) RODS BOve0i" Tauegular (M18 85°90 ETO 0. oO (a1 Ie: tm Vidar sans a nly eee eel ene, eee 120 [small (dilat. right) 120) no change 1 wk., slight change 
ee ee ear ee Neate as vats els edn ewocts's v[iwicine ec cceeecclesces > SP eet ee coos Peete er ee a-26 wie-0. - eee 99° 100° 0 RG Ses t120" geeecrcll erties Sl Rane acl naa rao Mo oe Space onc PSS or er oar 98: 994 34 90) oe alle) Scere cee | ecerreoie aie il! mot Soe aiecee meas, mace || sete a tiacars: Mets ratell ane alocerow memento leeate Ye ne ae Ae | en PRESS try Morne rity, a gasneiboncl a tyooe see ecu 
45 | 29 | 5-7 |146| 7 Mechanic 104 Good 11yrs.| 1 0 0 2 1 2 64 66 | 992 1003 0 Bee oo NOT Galles en nel ee eaat: 0 0 0 Vey eece Me lint 4108 Sal Sia ge aeee kate tone eae ee | eee A) ed Dea Seo an ern OU (RUSSO | | ee Bodh vuSacdeaneona, 
46 | 23 5-4 |114/10}...| Farmer 14 Good 6yrs.| 2 0 0 1 ene. | 995 1002 0 GS e190) eer eee ..| Light 0 Stomach 0 eee NA Tee ‘Weck oatlode ek sell eee Ta! We Heretics cel aaa erctey- epee sla cahc ape aeons tl gerard Gl aie a |e canalleancceccn’ca ene-cet > RRS Ree Rat Recetas cnet 
Gy | S| Mo? Sa 2 8 | Eating Bad | 1 yr.| 2 0 0 2 1 5 60 74]|.... 994] S. Apex | 83 85 |162 112 50/150 105 45] Light 0 OD aieallveers tere erate el lt ate ner Actes into eater taal |i ty ete a ic ar Chee eran lee Patieeton | ecinncr oh aqt.c hotell nea Pendle eee eg elle Jake 8 162 Tight: ||reeea eetercscre stein nteterstee wie ee sre eer eee 
48 | 27 5-53 |140|... 5 | Milkman 12 |(pts. Beer) Fair] 1 yr.| 1 |P-€%| Beers] 0 4 12 LINC at al Ge aie ere eee 62 72 |130 100 30/120 100 20] Light 0 Wn LA extn eee Poe el oc Eel ee ee seen se an {tae pene ees I ee A Pee et ERG seo oc ase | RN el ee eee eae wee 130 Tight Bi» 2 |g ; ema eee eeeicrtics er er nee eae 
49} 27 | 5-7 [128/18 ...)....05... fhe 9 Pair deyr.| 2: ) WO 3 el ee a Bae Uby 1A) ARBRE BITE A SATONBOL, oe wet dll ceed Peek Wada lone ol eae Ee pena es Se ageemiel es Ue absRadh ha ane Bee [ee ke Re ee AME yee ene 130 small |. 
DY eee CD LLE, )a2 od ana niof acne siieerns- Fair eyes} 0) || fOmglest0 4 Mate Seryth NO-<10 (10h: veo e00', 8686) Taphtahcscccsics|sebeeesdoatleurt s-seb. Fane eo ear Mem cere ear alline cone ates ie Besa heen: EGR es Geen ak. 62) tc act | abe Ma lee te al hei See Lh small ae Aen Sed Bees ROBE op 
BL [18 ese d48 |. .2 | He Laborer 12 Fair 1yr.| 2 #/ 0 | 2 1 ue Ep’ “in eee S$ erpeee Peegereccn oe toh ebu|lnkey by, NGI) WISE ane bo caoeocedbseaea opnca|beonmenouace Ese db callbcd yal lboor yall sath raat aN maApinae ate ence tou! Eom || Git Saat os) [hacer eeeeees G6. 84 [120 90. 80 [110 80 24 Jl svc lesesnanosaaeceee]Cewenm Maman ce atten ee ete ese 
52 | 21 | 5-5 (145)... 8 cn 9 Fair 1yr.| 1 4 1 9 3 peer | 008 LOOM ae aes ne WG 2A od Fimeea eae es ..| Light 0 0 0 De rim | oes Blige. Seria Pee ane ee (Unies Peres Sa arr ROA Perens Gao atoce CO dlubomoerccs. 55 0d0c | bdacee gone meena onOAEWionee sanded Heec Dna lonen podroscceincd oc. 
< 53 | 24 | 5-8+/121/ 5 ...] Machinist 13 Fair Lyr.| 2 #| 0 | 0 8 . .. ., | 991 1003] Negative | 68 .. 120 .. ..|.... ....| Ham 0 Cramps |....e.ce00s- Shree ita Cem ee ete a Ee eee (ee eat ne ener em Ge icc pee Mame 
BL P26 15-10+-| 164). 9B Jose. eee 9 Fair 2yrs.| 3 0 Seles 4 PPE (C008 O08 so arca cee te G4 een Same aie) oemiae | Walioht 0 8 ara eR Rae SEB ah Be Seal Roan Bee es 2 ib oon Renal Mee ator ne Roe eee a Rae eT ncn. 
‘ Doioet Yiteo | ds. We Student! lait. ace so Tobacco |1yr.| 2 !Manyl 0 6 7 98 9921 Hyper. 72... 120 Gen.lcond_poor'P. Light! 0 mes Rononnaaue ig! foe : Sr PHO SP ALOn Menino Wee lntao asec are Ye Ra nrmcpne ac PEcectcauriy 
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